Visits & medical services prices at Saint Alphonsus Medical Center Ontario

Ontario, OR · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedurePosted cashPosted gross× Medicare
1St psychiatric collab care mgmt 1st 70 mins (99492) $70.20 $108 0.6×
Admn Sarscov2 Vacc 1 Dose (90480) $14.27 $21.96 0.3×
Advncd Care Plan 30 Min (99497) $70.20 $108 0.6×
Aep neurodiagnostic i&r (92653) $527.15 $811 2.2×
Airway Inhalation Treatment (94640) $171.60 $264 0.7×
Analyze neurostim complex (95972) $110.50 $170 1.0×
Analyze neurostim no prog (95970) $97.50 $150 0.7×
Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) $52 $80 3.6×
Application Modality 1/> Areas Infrared (97026) $59.80 $92 9.0×
Application on-body injector (96377) $100.10 $154 1.9×
Assessment of aphasia per hr (96105) $245.05 $377 2.5×
Audiometry Air & Bone (92553) $118.30 $182 0.8×
Behavral qualit analys voice (92524) $312.65 $481 2.9×
Bfb traing w/EMG &/manometry 1st 15 min cntct (90912) $84.50 $130 1.0×
Bfb training ea addl 15 min (90913) $84.50 $130 2.6×
Biofeedback training any modality (90901) $91.65 $141 2.2×
Blink reflex test (95933) $87.75 $135 1.3×
Breathing response to hypoxia (94450) $118.30 $182 0.8×
Brief Emotional/Behav Assmt (96127) $29.90 $46 0.7×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $572 $880 1.4×
Caloric Vstblr Test W/Rec (92537) $118.30 $182 0.8×
Canalith repositioning proc (95992)
range across 2 matching MRF lines		 $11.70–$100.75 $18–$155 varies
Cardiac Stress Tst,Tracing Only (93017) $718.25 $1,105 3.0×
Cardiopulmonary exercise testing (94621) $681.85 $1,049 1.6×
Cardiopulmonary resuscitation (92950) $741.65 $1,141 3.1×
Cardioversion (92960) $1,484.60 $2,284 2.0×
Cardioversion elective internal (92961) $1,529.45 $2,353 2.1×
Caregiver hlth risk assmt score doc stnd instrm (96161) $22.75 $35 0.5×
Cbt 1st hour (94644) $154.05 $237 1.0×
Chemo Anti-Neopl Sq/Im (96401) $162.50 $250 2.0×
Chemo Hormon Antineopl Sq/Im (96402) $130 $200 1.6×
Chemo IV infusion addl hr (96415) $172.25 $265 2.2×
Chemo IV push addl drug (96411) $281.45 $433 3.5×
Chemother Prolong Infuse W/Pump (96416) $713.05 $1,097 1.9×
Chemotherapy Unspecified (96549) $205.40 $316 3.9×
Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) $239.20 $368 3.0×
Chemotx admn IV nfs tq up 1 hr 1/1st sbst/drug (96413) $679.90 $1,046 1.9×
Chemotx admn IV push tq 1/1st sbst/drug (96409) $403 $620 1.1×
Chemotx Njx Subarachnd/Intraventr Rsvr 1/Mult (96542) $255.45 $393 0.7×
Chest Wall Manipulation (94668) $141.70 $218 1.0×
Chron Care Mgmt Srvc 20 Min (99490) $70.20 $108 0.6×
Color/duplex Doppler, complete (93975) $801.45 $1,233 3.0×
Color/duplex Doppler, limited (93976) $779.35 $1,199 6.7×
Community/Work Reintegration Trainj Ea 15 Min (97537) $78 $120 2.4×
Complex chronic care mgmt svc 1st 60 min cal mo (99487) $121.55 $187 0.6×
Comprehensive Hearing Test (92557) $118.30 $182 0.8×
Computerized Ophthalmic Imaging Optic Nerve (92133) $44.85 $69 0.7×
Computerized Ophthalmic Imaging Retina (92134) $44.85 $69 0.7×
Continuous Pulse Ox (94762) $188.50 $290 1.3×
Cpap Ventilation Cpap Initiation&Mgmt (94660) $596.70 $918 2.5×
Cpt initial (94667) $173.55 $267 1.2×
Critical care first hour (99291)
range across 3 matching MRF lines		 $3,513.90–$6,421.35 $5,406–$9,879 varies
Debridement Open Wound 20 Sq Cm< (97597)
range across 3 matching MRF lines		 $336.70–$360.10 $518–$554 varies
Developmental tst admin phys/qhp 1st hour (96112)
range across 4 matching MRF lines		 $118.30–$276.25 $182–$425 varies
Dup-scan aorta ivc iliac vascl/bpgs complete (93978) $618.80 $952 2.3×
Dup-scan aorta ivc iliac vascl/bpgs uni/lmtd (93979) $482.30 $742 4.2×
Dup-scan lxtr art/artl bpgs compl bi study (93925) $651.30 $1,002 2.5×
Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) $434.20 $668 3.7×
Dup-Scan Xtr Veins Complete Bilateral Study (93970) $941.20 $1,448 3.5×
Dup-scan xtr veins unilateral/limited study (93971) $609.70 $938 5.2×
Duplex Scan Artl Infl&Ven O/F Hemo Compl Uni Std (93986) $253.50 $390 2.2×
Duplex up extrem art bilat (93930) $563.55 $867 2.1×
Duplex up extrem art unilat/ltd (93931) $375.70 $578 3.2×
Echo Congenital Complete (93303) $1,375.40 $2,116 2.3×
Echo Heart Xthoracic,Limited (93308) $693.55 $1,067 2.6×
Echo tthrc r-t 2d w/wo m-mode rest&strs cont ECG (93351) $2,037.75 $3,135 3.4×
EEG awake and asleep (95819) $1,008.15 $1,551 4.2×
EEG awake drowsy (95816) $1,008.15 $1,551 4.2×
Eeg Sleep Only (95822) $925.60 $1,424 3.9×
Elec Alys Implt Smpl Cn Npgt Prgrmg (95976) $34.45 $53 0.8×
Electrical Stimulation Ea 15 Min (97032) $63.70 $98 4.3×
Electrocardiogram Tracing (93005) $248.95 $383 3.8×
Emergency Dept Visit Level 2 (99282) $423.80 $652 2.5×
Emergency Dept Visit Level 3 (99283) $837.20 $1,288 2.8×
Emergency Dept Visit Level 4 (99284)
range across 4 matching MRF lines		 $1,314.95–$4,327.05 $2,023–$6,657 varies
Er level 1 (99281) $223.60 $344 2.4×
Er level v (99285)
range across 7 matching MRF lines		 $1,832.35–$6,421.35 $2,819–$9,879 varies
Eval aud funcj cand/po surg implt dev 1st hr (92626) $262.60 $404 1.8×
Evaluate Speech Production (92522) $312.65 $481 2.8×
Evaluate Swallowing Function (92610) $319.15 $491 3.8×
Evaluation of speech fluency (92521) $312.65 $481 2.3×
External ECG rec>48hr<7d recording (93242) $402.35 $619 9.7×
External ECG rec>7d<15d recording (93246) $402.35 $619 9.7×
Extracranial Bilat Study (93880) $779.35 $1,199 2.9×
Extracranial Uni/Ltd Study (93882) $717.60 $1,104 6.2×
F-up/limited tthrc echo congenital car anomaly (93304) $1,021.80 $1,572 1.7×
Flexible endoscopic eval swallow c/v rec (92612) $310.70 $478 1.6×
Fundus photography (92250) $97.50 $150 0.7×
Health Behavior Assessment/Re-Assessment (96156) $70.20 $108 0.6×
Health behavior ivntj fam w/pt f2f 1st 30 min (96167) $22.75 $35 0.5×
Health behavior ivntj group f2f 1st 30 min (96164) $22.75 $35 0.5×
Health behavior ivntj indiv f2f 1st 30 min (96158) $121.55 $187 0.6×
Holter monitor recording (93225) $402.35 $619 2.7×
Im Adm Intransl/Oral 1 Vaccine (90473)
range across 2 matching MRF lines		 $14.27–$53.95 $21.96–$83 varies
Immunization administration (90471)
range across 2 matching MRF lines		 $14.27–$61.10 $21.96–$94 varies
Inhlj Brncl Challenge Tstg W/Histam/Methachol (95070) $812.50 $1,250 2.0×
Iontophoresis 15 min (97033) $67.60 $104 3.6×
Irrig Drug Delivery Device (96523) $149.50 $230 2.3×
IV infusion hydration each additional hour (96361) $159.25 $245 3.1×
IV infusion hydration initial 31 min-1 hour (96360) $564.20 $868 2.4×
IV infusion ther proph addl sequential to 1 hr (96367) $194.35 $299 2.4×
IV infusion therapy prophylaxis/dx ea hour (96366) $156 $240 3.0×
IV push initial (96374) $371.15 $571 1.6×
Laryngeal Function Studies (92520) $247.65 $381 1.7×
Liver Elastography W/O Imag W/I&R (91200) $287.95 $443 2.0×
Lung Function Test (Mbc/Mvv) (94200) $157.30 $242 2.4×
Mechanical chest wall oscillation per session (94669) $160.55 $247 0.7×
Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) $32.50 $50 1.0×
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $38.35 $59 1.0×
Medical nutrition therapy grp2/ indiv ea 30 mi (97804) $19.50 $30 1.1×
Methacholine challenge (94070) $791.70 $1,218 1.9×
Motion Fluoroscopy/Swallow (92611) $295.75 $455 3.2×
Muscle Test 2 Limbs (95861) $149.50 $230 1.0×
Muscle Test Hemidiaphragm (95866) $155.35 $239 1.1×
Nasopharyngoscopy (92511) $146.90 $226 0.7×
Needle Emg Thrc Paraspi Musc Excluding T1/T12 (95869) $235.30 $362 1.0×
Neg Pressure Wound Therapy Non Dme </= 50 Sq Cm (97607) $408.20 $628 0.9×
Neg Pressure Wound Therapy Non Dme >50 Sq Cm (97608) $532.35 $819 1.2×
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) $148.20 $228 0.7×
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) $271.05 $417 0.6×
Nerve Conduction Studies 1-2 Studies (95907) $118.30 $182 0.5×
Nerve conduction studies 13 or more studies (95913) $401.05 $617 1.0×
Neuromuscular Junct Tstg Ea Nrv Any 1 Meth (95937) $141.70 $218 1.0×
Neuromuscular Reeducation (97112) $70.20 $108 2.1×
Newborn resuscitation (99465) $364 $560 0.5×
Nitric oxide expired gas determination (95012) $113.10 $174 2.7×
Oph bmtry prtl coher intrfrmtry io lens pwr cal (92136) $175.50 $270 1.2×
Oral Function Therapy (92526) $238.55 $367 2.8×
Oral Speech Device Eval (92597) $247.65 $381 3.5×
Orthc/Prostc Mgmt Sbsq Enc (97763) $73.45 $113 1.5×
Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) $73.45 $113 1.6×
Osteopathic Manipulative Tx 1-2 Body Regions (98925) $25.35 $39 1.1×
Osteopathic manipulative tx 3-4 body regions (98926) $35.10 $54 1.5×
Ot eval high complexity (97167) $204.10 $314 2.0×
Ot Eval Low Complex (97165) $172.25 $265 1.7×
Ot Eval Moderate Complexity (97166) $187.85 $289 1.9×
Ot manual therapy 15 min (97140) $61.75 $95 2.2×
Ot paraffin bath (97018) $66.30 $102 11.0×
Ot Prosthetic Training, Each 15 Min (97761) $73.45 $113 1.8×
Ot Re-Eval Est Plan Care (97168) $172.25 $265 2.5×
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $155.35 $239 1.1×
Outpatient Cardiac Rehab W/O Cont Ecg Monitor (93797) $151.45 $233 1.1×
Pentamidine Aersl Inhalation Pneumocystis/Proph (94642) $280.15 $431 1.2×
Phlebotomy therapeutic (99195) $199.55 $307 1.3×
Phys/qhp svcs op pulm rehab w/cont oximtry mntr (94626) $129.35 $199 2.0×
Phys/qhp svcs op pulm rehab wo cont oximtry mntr (94625) $128.05 $197 2.0×
Physical Performance Test (97750)
range across 5 matching MRF lines		 $63.70–$67.60 $98–$104 varies
Plethysmography (94726) $447.20 $688 1.1×
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $3,029 $4,660 3.2×
Polysom <6 yrs 4/> paramtrs (95782) $3,029 $4,660 3.2×
Positional nystagmus test (92542) $97.50 $150 0.7×
Prgrmng Dev Eval Implantable in Persn 1 Ld Dfb (93282) $128.05 $197 3.1×
Psych diag eval w/med srvcs (90792) $189.15 $291 1.0×
Psychiatric diagnostic evaluation (90791) $172.25 $265 0.9×
Pt Eval High Complex (97163) $204.10 $314 2.1×
Pt eval low complex 20 min (97161) $172.25 $265 1.8×
Pt Eval Mod Complex (97162) $187.85 $289 1.9×
Pt gait training 15 min (97116) $68.25 $105 2.3×
Pt mechanical traction (97012) $61.75 $95 4.3×
Pt Re-Eval Est Plan Care (97164) $172.25 $265 2.6×
Pt-focused hlth risk assmt score doc stnd instrm (96160) $22.75 $35 0.5×
Pulm function test by gas (94727) $259.35 $399 1.1×
Pulmonary service/procedure (94799) $241.15 $371 1.7×
Pulmonary Stress Testing (94618) $319.15 $491 2.2×
Pure Tone Audiometry Air (92552) $63.70 $98 0.4×
Rem Interrog Scrms <30 D Phys/Qhp (93298) $136.50 $210 3.3×
Remote 30 Day Ecg Rev/Report (93270) $601.25 $925 14.5×
Respiratory flow volume loop (94375) $235.30 $362 1.0×
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) $202.80 $312 0.9×
Rx sp-genratj augmnt&comunicaj dev 1st hr (92607) $314.60 $484 2.6×
Sbsq Psyc Collab Care Mgmt (99493) $70.20 $108 0.6×
Self Care Mngment Training (97535) $67.60 $104 2.1×
Sensory Integration Ea 15 Min (97533) $58.50 $90 1.0×
Sleep study unattended (95806) $504.40 $776 2.1×
Speech sound lang comprehen (92523) $312.65 $481 1.4×
Spirometry (94010) $418.60 $644 1.7×
Spontaneous Nystagmus Test (92541) $97.50 $150 0.7×
Standardized Cognitive Performance Testing (96125) $245.70 $378 2.4×
Stress Tte Only (93350) $1,336.40 $2,056 2.2×
Subcutaneous Infusion Each Additional Hour (96370) $35.10 $54 0.7×
Subcutaneous infusion initial 1 hr w/pump set-up (96369) $314.60 $484 1.3×
Subq Infusion Additional Pump Infusion Site (96371) $124.15 $191 1.6×
Surfactant Admin Thru Tube (94610) $323.05 $497 1.3×
Ther Ivntj Cog Funcj Cntct 1st 15 Minutes (97129) $67.60 $104 3.0×
Ther Ivntj Ea Addl 15 Min (97130) $67.60 $104 3.2×
Ther Px 1/> Areas Each 15 Min Aqua Ther W/Xerss (97113) $70.20 $108 1.9×
Ther Px 1/> Areas Each 15 Minutes Massage (97124) $67.60 $104 2.3×
Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) $245.05 $377 2.4×
Ther/Prop/Diag Inj/Inf Proc (96379) $205.40 $316 3.9×
Ther/Proph/Diag Inj Ia (96373) $159.25 $245 0.7×
Ther/Proph/Diag Inj Sc/Im (96372) $155.35 $239 1.9×
Ther/Proph/Diag Iv Inf Init (96365) $605.15 $931 2.6×
Therapeutic Activities (97530)
range across 4 matching MRF lines		 $66.30–$70.20 $102–$108 varies
Tobacco Use Cessation Intensive >10 Minutes (99407) $20.80 $32 0.5×
Tobacco Use Cessation Intermediate 3-10 Minutes (99406) $22.75 $35 0.5×
Trans Care Mgmt 14 Day Disch (99495) $150.80 $232 1.0×
Trans Care Mgmt 7 Day Disch (99496) $190.45 $293 1.3×
Tte w/doppler, complete (93306) $1,817.40 $2,796 3.0×
Tte W/O Doppler Complete (93307) $812.50 $1,250 3.1×
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $252.85 $389 3.3×
Tx/Pro/Dx Inj New Drug Addon (96375) $205.40 $316 3.9×
Tympanometry (92567) $29.90 $46 0.7×
Upr/L Xtremity Art 2 Levels (93922)
range across 2 matching MRF lines		 $217.10–$250.25 $334–$385 varies
Upr/Lxtr Art Stdy 3+ Lvls (93923)
range across 2 matching MRF lines		 $299.65–$321.75 $461–$495 varies
Vasopneumatic device (97016) $55.25 $85 4.6×
Veeg Ea 12-26 Hr Unmntr (95714) $1,783.60 $2,744 4.3×
Vent Mgmt Inpat Init Day (94002) $1,760.20 $2,708 2.6×
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $1,558.70 $2,398 2.3×
Visual Evoked Potential Test (95930) $235.30 $362 1.0×
Visual Field Exam Extended (92083) $97.50 $150 0.7×
Vital capacity, total (94150) $134.55 $207 0.9×
Wheelchair Mgmt Ea 15 Min (97542) $65 $100 2.1×
Whirlpool Therapy (97022) $74.10 $114 4.7×

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.