Visits & medical services prices at Ridgeview Sibley Medical Center

Arlington, MN · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Advance care planning first 30 mins (99497) $283
Airway inhalation treatment (94640) $80.20 $64.77 0.4×
Anogenital examination, magnified, in childhood for suspected trauma, including image recording when performed Facility (99170) $187.85 $289 0.9×
Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) $87.10 $134 6.1×
Application on-body injector (96377) $58.50 $90 1.2×
Assessment of aphasia per hr (96105) $344.50 $530 3.5×
Basic vestibular evaluation (92540) $239.20 $368 1.1×
Bedside Swallowing Eval (92610) $315.90 $486 3.7×
Brief Emotional/Behavioral Assessment (96127) $17
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $87.75 $131 0.2×
Canalith Repositioning Procedure (95992) $148.20 $228 3.6×
Cardiac Stress Tst,Tracing Only (93017) $650 $1,000 2.9×
Cardiopulmonary resuscitation (92950) $546.65 $841 2.5×
Cardioversion (92960) $713.38 $1,097.50 1.0×
Chemo Hormon Antineopl Sq/Im (96402) $109.80 $168.92 1.5×
Chemo IV push addl drug (96411) $210.31 $323.56 2.8×
Chemo prolong 8+ hrs infuse w/pump (96416) $495.10 $761.69 1.5×
Chemother, IV infusion, 1 hr (96413) $354.80 $545.84 1.0×
Chemother, IV infusion, ea add hr (96415) $215.52 $331.57 2.9×
Chemother,Non-Hormone Anti-Neopl, Sub-Q/Im (96401) $162.12 $249.42 2.2×
Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) $228.18 $351.06 3.1×
Chemotx admn IV push tq 1/1st sbst/drug (96409) $285.43 $439.12 0.8×
Chronic care management services 1st 20 min (99490) $111.80 $194.50 1.1×
Color/duplex Doppler, complete (93975) $897 $1,380 3.6×
Color/duplex Doppler, limited (93976) $677.95 $1,043 6.3×
Cpap/bipap (94660) $590.20 $908 2.6×
Critical care (99291) $1,131.32 $1,740.50 1.3×
Dbrdmt prmlg les w/pdt (96574) $622.70 $958 3.0×
Debridement Open Wound 20 Sq Cm< (97597) $178.10 $274 0.9×
Dup-scan aorta ivc iliac vascl/bpgs uni/lmtd (93979) $462.15 $711 4.3×
Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) $631.80 $972 5.9×
Dup-Scan Uxtr Art/Artl Bpgs Uni/Lmtd Study (93931) $52 $80 0.5×
Dup-Scan Xtr Veins Complete Bilateral Study (93970) $744.90 $1,146 3.0×
Dup-scan xtr veins unilateral/limited study (93971) $626.92 $964.50 5.8×
Duplex scan extracranial art compl bi study (93880) $800.80 $1,232 3.3×
Echo Heart Xthoracic,Limited (93308) $360.42 $554.50 1.5×
EEG awake and asleep (95819) $125.45 $193 0.6×
Electrocardiogram Tracing (93005) $166.40 $256 2.7×
EMG one extremity (95860) $111.80 $172 0.8×
Er level 1 (99281) $26 $40 0.3×
Er level ii (99282) $92.95 $143 0.6×
Er level iii (99283) $157.95 $243 0.6×
Er level IV (99284) $268.45 $413 0.6×
Er level v (99285) $388.70 $598 0.6×
Eval speech sound production (92522) $305.50 $470 2.7×
Evaluate Pt Use Of Inhaler (94664) $94.25 $145 0.4×
External ECG rec>48hr<7d recording (93242) $193.70 $170 5.0×
External ECG rec>7d<15d recording (93246) $193.70 $170 5.0×
Gastroesophag reflx test w/telemtry ph eltrd (91035) $178.75 $275 0.2×
Imm admn sarscov2 vaccine single dose (90480) $37.05 $57 0.9×
Immune Admin Oral/Nasal (90473) $39.61
Immunization Admin (90471) $72
Inital newborn e/m (99460) $206.05 $317 1.5×
Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant admitted and… (99463) $240.50 $370 1.8×
Iontophoresis 15 min (97033) $122.85 $189 6.5×
Irrig drug delivery device (96523) $104.84 $161.30 1.7×
IV infusion hydration each additional hour (96361) $145.16 $223.32 3.0×
IV infusion hydration initial 31 min-1 hour (96360) $222.22 $341.87 1.0×
IV infusion ther proph addl sequential to 1 hr (96367) $188.06 $289.32 2.5×
IV infusion, therap/proph/diagnost,initial,1st hour (96365) $284.53 $437.74 1.3×
IV infusion, therap/proph/diagnost,initial,ea add hour (96366) $178.42 $274.48 3.7×
IV push ea addl new drug (96375) $102.90 $158.31 2.1×
IV push initial (96374) $132 $203.07 0.6×
Manual therapy 15 min (97140) $94.25 $145 3.4×
Mechanical traction (97012) $90.35 $139 6.3×
Motion Fluor Eval Swlng Funcj C/V Rec (92611) $203.45 $313 2.2×
Multiple Sleep Latency Test (95805) $126.10 $194 0.1×
Nasopharyngoscopy (92511) $84.50 $130 0.4×
Neg press wound tx >50 cm (97608) $55.90 $86 0.1×
Neg Pressure Wound Therapy Non Dme </= 50 Sq Cm (97607) $47.45 $73 0.1×
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) $161.20 $248 0.8×
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) $197.92 $304.50 0.5×
Newborn resuscitation (99465) $315.25 $485 0.5×
Non-Invas Physiologic Std Extremity Art 2 Level (93922) $26.65 $41 0.2×
Noninvasive Ear/Pulse Oximetry Overnight Monitor (94762) $250.90 $386 1.9×
Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) $105.95 $163 2.3×
Ot eval high complex 60 min (97167) $297.70 $458 3.0×
Ot eval low complex 30 min (97165) $230.75 $355 2.3×
Ot eval mod complex 45 min (97166) $258.70 $398 2.6×
Ot Orthotics/Prosth Mgmt &/Trainj Sbsq Enctr 15 Min (97763) $94.90 $146 1.9×
Ot re-evaluation (97168) $175.50 $270 2.6×
Ot therapeutic activity 15 min (97530) $90.35 $139 2.6×
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $230.10 $354 1.7×
Phlebotomy therapeutic (99195) $113.04 $173.90 0.8×
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $270.40 $416 0.3×
Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx (95115) $36
Psych diag eval w/med srvcs (90792) $380.25 $585 2.1×
Psychiatric diagnostic evaluation (90791) $331.50 $510 1.8×
Psycl tst eval phys/qhp 1st (96130) $243.10 $374 1.1×
Psytx crisis initial 60 min (90839) $289.90 $446 1.6×
Pt Electrical Stimulation (97032) $46.80 $72 3.2×
Pt eval high complex 45 min (97163) $270.40 $416 2.8×
Pt eval low complex 20 min (97161) $203.45 $313 2.1×
Pt eval mod complex 30 min (97162) $215.80 $332 2.2×
Pt gait training 15 min (97116) $90.35 $139 3.1×
Pt Neuromusc Reeducat,1+ Areas, Ea 15 Min (97112) $89.70 $138 2.7×
Pt Physical Performance Test (97750) $102.70 $158 3.0×
Pt re-evaluation (97164) $113.75 $175 1.7×
Pt Self-Care/Home Mgmt Training Each 15 Minutes (97535) $90.35 $139 2.8×
Pt-focused hlth risk assmt (96160) $7.15 $11 0.2×
Rem mntr physiol param 1st set up pt educaj eqp (99453) $44.85 $69 0.3×
Rem mntr physiol param dev (99454) $106.60 $164 2.8×
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) $258.05 $397 1.2×
Smoking cessation > 10 min (99407) $55.90 $86 1.4×
Speech sound lang comprehen (92523) $305.50 $470 1.3×
Spirometry (94010) $61.75 $95 0.3×
Standardized Cognitive Performance Testing (96125) $338.65 $521 3.3×
Temp transcutaneous pacing (92953) $2.60 $4 0.0×
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $99.45 $153 4.4×
Ther Ivntj Cog Funcj Cntct Ea Addl 15 Minutes (97130) $99.45 $153 4.7×
Ther/prop/diag inj/inf proc (96379) $167.70 $258 3.5×
Therapeutic prophylactic/dx injection subq/im (96372) $50
Tobacco Use Cessation Intermediate 3-10 Minutes (99406) $26.65 $41 0.7×
Trans Care Mgmt 14 Day Disch (99495) $715
Trans Care Mgmt 7 Day Disch (99496) $966
Tte w/doppler, complete (93306) $1,705.60 $2,624 3.0×
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $268.45 $413 3.5×
Tx Swallowing Dysfunction&/Oral Funcj Feeding (92526) $158.60 $244 1.9×
Vasopneumatic device (97016) $106.60 $164 8.9×
Vent mgmt inpat init day (94002) $632.45 $973 1.0×