Visits & medical services prices at Portneuf Medical Center

Pocatello, ID · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedurePosted cashPosted gross× Medicare
Ablate Heart Dysrhythm Focus (93650) $14,030.10 $23,383.50 1.8×
Airway Inhalation Treatment (94640) $241.50 $402.50 1.1×
Anogenital Xm Magnify Child/Suspect Trauma W Img (99170) $475.20 $792 2.4×
Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) $82.20 $137 5.7×
Application on-body injector (96377) $96 $160 2.1×
Assessment of aphasia per hr (96105) $179.40 $299 1.8×
Behavral qualit analys voice (92524) $441.60 $736 4.0×
Breath hydrogen/methane test (91065) $534.60 $891 2.5×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $632.10 $1,053.50 1.7×
Bundle of his recording (93600) $20,700 $34,500 2.7×
Canalith repositioning proc (95992) $168 $280 4.1×
Car seat/bed test 60 min (94780) $150 $250 4.1×
Cardiac Stress Tst,Tracing Only (93017) $1,119 $1,865 5.2×
Cardiopulmonary exercise testing (94621) $161.70 $269.50 0.4×
Cardiopulmonary resuscitation (92950) $3,987.60 $6,646 18.7×
Cardioversion (92960) $1,668.66 $2,781.10 2.6×
Cardioversion elective internal (92961) $2,134.80 $3,558 3.3×
Caregiver Training Strategies&Tq Ea Addl 15 Min (97551) $46.80 $78 1.8×
Cath Place/Coron Angio, Img Super/Interp,R&L Hrt Cath, L Hrt Ventric (93460) $13,459.74 $22,432.90 4.2×
Cath Place/Coron Angio, Img Super/Interp,W Left Heart Ventriculography (93458) $18,819.60 $31,366 5.9×
Cbt 1st hour (94644) $298.20 $497 2.3×
Chemo Anti-Neopl Sq/Im (96401) $228.06 $380.10 3.2×
Chemo Hormon Antineopl Sq/Im (96402) $165.06 $275.10 2.3×
Chemo Ia Push (96420) $282 $470 0.9×
Chemo IV infusion addl hr (96415) $183 $305 2.6×
Chemo IV push addl drug (96411) $128.52 $214.20 1.8×
Chemother Prolong Infuse W/Pump (96416) $599.76 $999.60 1.8×
Chemotherapy Into Cns (96450) $745.20 $1,242 2.3×
Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) $196.20 $327 2.8×
Chemotx admn IV nfs tq up 1 hr 1/1st sbst/drug (96413) $974.40 $1,624 3.0×
Chemotx admn IV push tq 1/1st sbst/drug (96409) $333.90 $556.50 1.0×
Chest Wall Manipulation (94668) $226.80 $378 1.7×
Chron Care Mgmt Srvc 20 Min (99490) $126.42 $210.70 1.3×
Color/duplex Doppler, complete (93975) $836.40 $1,394 3.5×
Color/duplex Doppler, limited (93976) $1,087.32 $1,812.20 10.5×
Community/Work Reintegration Trainj Ea 15 Min (97537) $149.40 $249 4.7×
Complex chronic care mgmt svc 1st 60 min cal mo (99487) $313.20 $522 1.8×
Continuous Pulse Ox (94762) $273 $455 2.1×
Coronary Art/Grft Angio S&I (93455) $12,641.58 $21,069.30 3.9×
Coronary Artery Angio S&I (93454) $8,618.10 $14,363.50 2.7×
Cpap Ventilation Cpap Initiation&Mgmt (94660) $693.42 $1,155.70 3.2×
Cpt initial (94667) $435.60 $726 3.3×
Critical care first hour (99291) $4,143.60 $6,906 5.1×
Debridement Open Wound 20 Sq Cm< (97597)
range across 2 matching MRF lines		 $589.26–$841.80 $982.10–$1,403 varies
Developmental tst admin phys/qhp 1st hour (96112) $313.20 $522 2.5×
Dup-scan aorta ivc iliac vascl/bpgs complete (93978) $850.98 $1,418.30 3.6×
Dup-scan aorta ivc iliac vascl/bpgs uni/lmtd (93979) $594 $990 5.8×
Dup-scan lxtr art/artl bpgs compl bi study (93925) $501.48 $835.80 2.1×
Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) $529.20 $882 5.1×
Dup-Scan Xtr Veins Complete Bilateral Study (93970) $722.40 $1,204 3.1×
Dup-scan xtr veins unilateral/limited study (93971) $595.20 $992 5.8×
Duplex Scan Artl Infl&Ven O/F Hemo Compl Bi Std (93985) $407.82 $679.70 1.7×
Duplex Scan Artl Infl&Ven O/F Hemo Compl Uni Std (93986) $204.60 $341 2.0×
Duplex Scan Hemodialysis Access (93990) $394.80 $658 3.8×
Duplex up extrem art bilat (93930) $718.20 $1,197 3.0×
Duplex up extrem art unilat/ltd (93931) $370.44 $617.40 3.6×
ECG/monitoring and analysis (93271) $233.40 $389 2.5×
Echo Congenital Complete (93303) $2,521.80 $4,203 4.7×
Echo Heart Xthoracic,Limited (93308) $766.80 $1,278 3.3×
Echo transesophag montr cardiac pump functj (93318) $1,338 $2,230 2.5×
Echo transesophageal (93312) $2,107.56 $3,512.60 3.9×
Eeg 41-60 Minutes (95812) $652.80 $1,088 3.1×
EEG awake and asleep (95819) $909 $1,515 4.3×
EEG awake drowsy (95816) $864 $1,440 4.1×
EEG cont rec w/video by tech min 8 channels (95700) $633 $1,055 3.0×
EEG extended monitoring 61-119 minutes (95813) $864 $1,440 4.1×
Eeg Sleep Only (95822) $443.10 $738.50 2.1×
Eeg W/O Vid 2-12 Hr Unmntr (95705) $633 $1,055 3.0×
EEG wo vid ea 12-26hr unmntr (95708) $1,213.20 $2,022 3.3×
Electrical Stimulation Ea 15 Min (97032)
range across 2 matching MRF lines		 $57.54–$82.20 $95.90–$137 varies
Electrocardiogram Tracing (93005) $398.40 $664 6.8×
Electroconvulsive Therapy (90870) $1,470.60 $2,451 1.7×
Electrophysiologic Follow-Up W/Pac/Rec W/Arrhyt (93624) $20,043 $33,405 2.6×
Electrophysiology Evaluation (93642) $2,718.60 $4,531 2.3×
Emergency Dept Visit Level 2 (99282) $839.79 $1,399.65 5.5×
Emergency Dept Visit Level 3 (99283) $1,333.08 $2,221.80 4.9×
Emergency Dept Visit Level 4 (99284) $1,718.01 $2,863.35 4.2×
Emg 3 Extremities (95863) $700.20 $1,167 5.5×
Endomyocardial Biopsy (93505) $6,941.40 $11,569 2.2×
Ep & ablate supravent arrhyt (93653) $43,151.55 $71,919.25 1.7×
Ep & ablate ventric tachy (93654) $46,470.90 $77,451.50 1.8×
Ep Compre Electrophysiologic Arrhythmia Induction (93620) $20,043 $33,405 2.6×
Ep Compre Electrophysiologic W/O Arrhyt Induction (93619) $15,604.80 $26,008 2.0×
Er level 1 (99281) $414.54 $690.90 5.0×
Er level v (99285) $3,035.97 $5,059.95 5.2×
Ergonovine provocation test (93024) $828.60 $1,381 1.9×
Esophgl funcj g-esop rflx impd eltrd prolng (91038) $1,449 $2,415 3.9×
Evaluate pt use of inhaler (94664) $483 $805 2.2×
Evaluate Speech Production (92522) $441.60 $736 3.9×
Evaluate Swallowing Function (92610) $309.12 $515.20 3.6×
Evaluation of speech fluency (92521) $428.40 $714 3.2×
External ECG rec>48hr<7d recording (93242) $33.18 $55.30 0.9×
External ECG rec>7d<15d recording (93246) $240.46 $400.77 6.5×
External Ecg Scanning Analysis Report (93226) $96 $160 1.6×
Extracranial Bilat Study (93880) $741.60 $1,236 3.1×
Extracranial Uni/Ltd Study (93882) $836.40 $1,394 8.1×
F-up/limited tthrc echo congenital car anomaly (93304) $1,439.34 $2,398.90 2.7×
Flexible endoscopic eval swallow c/v rec (92612) $352.20 $587 1.8×
Flexible ndsc eval swlng&laryn sens c/v rec (92616) $469.80 $783 2.1×
Fundus photography (92250) $303.24 $505.40 2.3×
Gastric motility studies (91020) $1,253.40 $2,089 3.4×
Gastroesophag Reflx Test W/Cath Ph Eltrd Plcmt (91034) $1,449 $2,415 3.9×
Gastroesophag Reflx Test W/Intrluml Imped Eltrd (91037) $822.90 $1,371.50 3.9×
Gastroesophag reflx test w/telemtry ph eltrd (91035) $1,449 $2,415 1.7×
Gi tract capsule endoscopy (91110) $1,872.60 $3,121 2.1×
Group Therapeutic Procedures (97150) $108 $180 6.0×
Heart catheterization, both sides, with coronary and bypass graft angiography (93461) $14,037.24 $23,395.40 4.4×
Holter monitor recording (93225) $91.20 $152 0.7×
Icd Device Interrogate (93289) $61.80 $103 1.7×
Icd device progr eval dual (93283) $106.68 $177.80 2.9×
Icd Device Progr Eval Mult (93284) $373.80 $623 10.1×
Icm Device Eval (93290) $33.60 $56 0.9×
Ilr Device Eval Progr (93285) $124.80 $208 3.4×
Ilr Device Interrogate (93291) $41.58 $69.30 1.5×
Immunization administration (90471) $176.40 $294 2.5×
Inhlj Brncl Challenge Tstg W/Histam/Methachol (95070) $409.80 $683 1.1×
Insert/Place Heart Catheter (93503) $4,858.98 $8,098.30 3.1×
Interrogate Subq Defib (93261) $152.40 $254 4.1×
Irrig Drug Delivery Device (96523) $267 $445 4.6×
IV infusion hydration each additional hour (96361) $310.80 $518 6.7×
IV infusion hydration initial 31 min-1 hour (96360) $641.94 $1,069.90 3.1×
IV infusion ther proph addl sequential to 1 hr (96367) $203.40 $339 2.9×
IV infusion therapy prophylaxis/dx ea hour (96366) $138.18 $230.30 3.0×
IV push initial (96374) $397.80 $663 1.9×
L Hrt Art/Grft Angio (93459) $13,751.22 $22,918.70 4.3×
Lung Function Test (Mbc/Mvv) (94200) $96 $160 1.6×
Lwr Xtr Vasc Stdy Bilat (93924) $538.80 $898 2.5×
Mechanical chest wall oscillation per session (94669) $176.40 $294 0.8×
Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) $40.80 $68 1.3×
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $40.80 $68 1.1×
Medical nutrition therapy grp2/ indiv ea 30 mi (97804) $31.20 $52 1.8×
Methacholine challenge (94070) $227.40 $379 0.6×
Motility study esophagus (91010) $1,537.38 $2,562.30 4.2×
Motion Fluoroscopy/Swallow (92611) $441.60 $736 4.8×
Multiple Sleep Latency Test (95805) $3,019.80 $5,033 3.6×
Muscle Test One Limb (95860) $418.80 $698 3.2×
Neg Pressure Wound Therapy Non Dme </= 50 Sq Cm (97607) $777 $1,295 1.9×
Neg Pressure Wound Therapy Non Dme >50 Sq Cm (97608) $800.40 $1,334 2.0×
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605)
range across 2 matching MRF lines		 $475.20–$617.76 $792–$1,029.60 varies
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606)
range across 2 matching MRF lines		 $845.40–$1,099.02 $1,409–$1,831.70 varies
Neurobehavioral Status Exam (96116) $661.20 $1,102 3.1×
Neuromuscular Reeducation (97112)
range across 2 matching MRF lines		 $123.48–$229.32 $205.80–$382.20 varies
Nitric oxide expired gas determination (95012) $29.40 $49 0.8×
O2 Uptk Exp Gas Alys W/Co2 Output % O2 Xtrc (94681) $648 $1,080 1.8×
Oral Function Therapy (92526) $315 $525 3.7×
Oral Speech Device Eval (92597) $279.60 $466 3.9×
Orthc/Prostc Mgmt Sbsq Enc (97763)
range across 2 matching MRF lines		 $82.20–$103.20 $137–$172 varies
Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) $82.20 $137 1.8×
Ot eval high complexity (97167) $740.40 $1,234 7.4×
Ot Eval Low Complex (97165) $247.20 $412 2.5×
Ot Eval Moderate Complexity (97166) $493.20 $822 4.9×
Ot manual therapy 15 min (97140)
range across 2 matching MRF lines		 $63.42–$90.60 $105.70–$151 varies
Ot Prosthetic Training, Each 15 Min (97761) $75 $125 1.9×
Ot Re-Eval Est Plan Care (97168) $211.80 $353 3.1×
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $265.80 $443 2.1×
Outpatient Cardiac Rehab W/O Cont Ecg Monitor (93797) $190.20 $317 1.5×
Pentamidine Aersl Inhalation Pneumocystis/Proph (94642) $835.20 $1,392 3.9×
Peripheral arterial disease rehab per session (93668) $144 $240 2.5×
Perq Tcat Plmt Ntrac St 2+Les 2+St 2+C Segments (92930) $33,712.20 $56,187 1.9×
Perq transcath closure pda (93582) $24,436.02 $40,726.70 1.3×
Perq Transcath Cls Mitral (93590) $34,908.60 $58,181 1.9×
Perq Trluml C Angioplasty 1 Maj C Art&/Branches (92920) $17,543.82 $29,239.70 3.1×
Perq Trluml Revsc Chrnc Tot Occls 1 C Art Antgrd (92943) $33,892.80 $56,488 3.0×
Phlebotomy therapeutic (99195) $378.60 $631 2.9×
Phys/qhp svcs op pulm rehab w/cont oximtry mntr (94626) $258.60 $431 4.4×
Phys/qhp svcs op pulm rehab wo cont oximtry mntr (94625) $164.22 $273.70 2.8×
Physical Performance Test (97750) $63 $105 1.9×
Plethysmography (94726) $1,019.70 $1,699.50 2.8×
Pm device eval in person (93288) $127.80 $213 3.5×
Pm device progr eval dual (93280) $118.86 $198.10 3.2×
Pm device progr eval multi (93281) $152.40 $254 4.1×
Pm Device Progr Eval Sngl (93279) $69.30 $115.50 1.9×
Pm/Icd Remote Tech Serv (93296) $62.40 $104 1.7×
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $2,113.86 $3,523.10 2.5×
Prgrmg Dev Eval Implantable Subq Lead Dfb System (93260) $38.40 $64 1.0×
Prgrmng Dev Eval Implantable in Persn 1 Ld Dfb (93282) $125.40 $209 3.4×
Prq Card Angio/Athrect 1 Art (92924) $23,550.24 $39,250.40 2.1×
Prq Card Stent W/Angio 1 Vsl (92928) $18,768.96 $31,281.60 1.6×
Prq Card Stent/Ath/Angio (92933) $44,067.60 $73,446 2.4×
Prq Revasc Byp Graft 1 Vsl (92937) $26,812.80 $44,688 2.4×
Prq trl rvs ch occ ant&rtrgr (92945) $21,229.80 $35,383 1.9×
Pt Eval High Complex (97163) $518.28 $863.80 5.3×
Pt eval low complex 20 min (97161) $247.20 $412 2.5×
Pt Eval Mod Complex (97162) $493.20 $822 5.0×
Pt gait training 15 min (97116) $105 $175 3.6×
Pt Re-Eval Est Plan Care (97164) $148.26 $247.10 2.2×
Pulm function test by gas (94727) $430.50 $717.50 2.0×
Pulmonary service/procedure (94799) $652.05 $1,086.75 5.1×
Pulmonary Stress Testing (94618) $484.20 $807 3.7×
R Hrt Art/Grft Angio (93457) $14,037.24 $23,395.40 4.4×
R hrt coronary artery angio (93456) $12,735.66 $21,226.10 4.0×
R&L Hrt Cath W/Ventriclgrphy (93453) $12,735.66 $21,226.10 4.0×
Refill/Maint Portable Pump (96521) $367.80 $613 1.8×
Rem interrog icpms <30 d phys/qhp (93297) $62.40 $104 1.7×
Rem Interrog Scrms <30 D Phys/Qhp (93298) $62.40 $104 1.7×
Rem mntr physiol param 1st dev supply ea 30 d (99454) $30 $50 0.8×
Rem mntr physiol param 1st set up pt educaj eqp (99453) $103.20 $172 0.8×
Remote 30 Day Ecg Rev/Report (93270) $513.60 $856 13.9×
Respiratory flow volume loop (94375) $269.40 $449 1.3×
Rhythm Ecg 1-3 Leads Tracing Only W/O I&R (93041) $231.60 $386 4.0×
Right Heart Cath (93451) $13,912.80 $23,188 4.3×
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) $643.80 $1,073 3.2×
Rx sp-genratj augmnt&comunicaj dev 1st hr (92607) $652.20 $1,087 5.3×
Rx Sp-Genratj Augmnt&Comunicaj Dev Ea 30 Min (92608) $330 $550 6.9×
Self Care Mngment Training (97535) $84.60 $141 2.6×
Sleep study unattended (95806) $1,212.90 $2,021.50 5.7×
Slp caregiver training 1st 30 min (97550)
range across 2 matching MRF lines		 $85.20–$91.80 $142–$153 varies
Speech sound lang comprehen (92523) $441.60 $736 2.0×
Spirometry (94010) $430.50 $717.50 2.0×
Ssep lower limbs (95926) $736.80 $1,228 3.5×
Standardized Cognitive Performance Testing (96125) $385.80 $643 3.8×
Stress Tte Only (93350) $2,783.82 $4,639.70 5.2×
Surfactant Admin Thru Tube (94610) $483 $805 2.2×
Ther Ivntj Cog Funcj Cntct 1st 15 Minutes (97129) $105 $175 4.7×
Ther Ivntj Ea Addl 15 Min (97130) $105 $175 5.0×
Ther Px 1/> Areas Each 15 Min Aqua Ther W/Xerss (97113) $142.80 $238 3.9×
Ther Px 1/> Areas Each 15 Minutes Massage (97124) $54 $90 1.8×
Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) $351 $585 3.4×
Ther/Proph/Diag Inj Sc/Im (96372) $176.40 $294 2.5×
Ther/Proph/Diag Iv Inf Init (96365) $1,238.25 $2,063.75 5.9×
Therapeutic Activities (97530) $102.60 $171 2.9×
Tilt table test with heart rhythm and blood pressure monitoring (93660) $2,099.76 $3,499.60 5.7×
Tobacco Use Cessation Intensive >10 Minutes (99407) $27 $45 0.7×
Tobacco Use Cessation Intermediate 3-10 Minutes (99406) $21.42 $35.70 0.6×
Transcath Closure of Asd (93580) $16,900.20 $28,167 0.9×
Transcranial Doppler Stdy Intracranial Art Lmtd (93888) $243 $405 2.4×
Tte w/doppler, complete (93306) $2,733.60 $4,556 5.1×
Tte W/O Doppler Complete (93307) $1,861.80 $3,103 7.9×
Tx atrial fib pulm vein isol (93656) $66,387 $110,645 2.6×
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $238.20 $397 3.1×
Tx/Pro/Dx Inj New Drug Addon (96375) $348.75 $581.25 7.5×
Unlisted cardiovascular service/procedure (93799) $323.40 $539 2.5×
Upr/L Xtremity Art 2 Levels (93922) $236.46 $394.10 1.8×
Upr/Lxtr Art Stdy 3+ Lvls (93923) $538.80 $898 2.5×
Valvuloplasty aortic valve (92986) $12,969.60 $21,616 2.3×
Valvuloplasty pulmonary valve (92990) $15,334.80 $25,558 1.3×
Veeg 2-12 hr unmonitored (95711) $633 $1,055 3.0×
Veeg Ea 12-26 Hr Unmntr (95714) $1,213.20 $2,022 3.3×
Veeg ea 12-26hr cont mntr (95716) $2,092.80 $3,488 2.5×
Vent Mgmt Inpat Init Day (94002) $1,371.60 $2,286 2.2×
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $1,246.80 $2,078 2.0×
Vital capacity, total (94150) $615 $1,025 4.8×
Wheelchair Mgmt Ea 15 Min (97542) $149.40 $249 4.8×

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.