Visits & medical services prices at Salem Memorial District Hospital
Salem, MO · every code in this section with a posted price and a Medicare benchmark.
107 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Airway Inhalation Treatment (94640) range across 12 matching MRF lines |
$187.50–$457.50 | $250–$610 | varies |
| Ambulatory bp mntr w/sw 24 hr+ recording only (93786) | $224.44 | $299.25 | 1.7× |
| Ambulatory bp mntr w/sw 24 hr+ scanning a/r (93788) | $172.50 | $230 | 1.3× |
| Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) range across 8 matching MRF lines |
$98.44–$102.38 | $131.25–$136.50 | varies |
| Brncdilat rspse spmtry pre&post-brncdilat admn (94060) | $405.75 | $541 | 1.1× |
| Cardiac Stress Tst,Tracing Only (93017) range across 3 matching MRF lines |
$52.50–$2,067.19 | $70–$2,756.25 | varies |
| Cardiopulmonary resuscitation (92950) range across 2 matching MRF lines |
$501.75–$672.75 | $669–$897 | varies |
| Cardioversion (92960) range across 2 matching MRF lines |
$262.50–$860.25 | $350–$1,147 | varies |
| Cbt 1st hour (94644) | $172.50 | $230 | 1.3× |
| Chemo Anti-Neopl Sq/Im (96401) | $192.94 | $257.25 | 2.7× |
| Chest Wall Manipulation (94668) | $112.50 | $150 | 0.8× |
| Community/Work Reintegration Trainj Ea 15 Min (97537) | $141.75 | $189 | 4.4× |
| Continuous Pulse Ox (94762) | $213.75 | $285 | 1.7× |
| Cpap Ventilation Cpap Initiation&Mgmt (94660) | $288 | $384 | 1.3× |
| Cpt initial (94667) | $172.50 | $230 | 1.3× |
| Critical care first hour (99291) range across 3 matching MRF lines |
$567–$1,902 | $756–$2,536 | varies |
| Debridement Open Wound 20 Sq Cm< (97597) | $275.25 | $367 | 1.4× |
| Dup-scan lxtr art/artl bpgs compl bi study (93925) | $1,082.81 | $1,443.75 | 4.5× |
| Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) | $543.38 | $724.50 | 5.2× |
| Dup-Scan Xtr Veins Complete Bilateral Study (93970) | $1,082.81 | $1,443.75 | 4.5× |
| Dup-scan xtr veins unilateral/limited study (93971) | $543.38 | $724.50 | 5.2× |
| Duplex up extrem art bilat (93930) | $1,082.81 | $1,443.75 | 4.5× |
| Duplex up extrem art unilat/ltd (93931) | $543.38 | $724.50 | 5.2× |
| Eeg 41-60 Minutes (95812) | $405.75 | $541 | 1.9× |
| Electrical Stimulation Ea 15 Min (97032) range across 8 matching MRF lines |
$114.19–$145.69 | $152.25–$194.25 | varies |
| Electrocardiogram Tracing (93005) range across 4 matching MRF lines |
$85.50–$192.94 | $114–$257.25 | varies |
| Emergency Dept Visit Level 2 (99282) range across 4 matching MRF lines |
$145.69–$350.25 | $194.25–$467 | varies |
| Emergency Dept Visit Level 3 (99283) range across 3 matching MRF lines |
$173.25–$611.25 | $231–$815 | varies |
| Emergency Dept Visit Level 4 (99284) range across 3 matching MRF lines |
$255.75–$949.50 | $341–$1,266 | varies |
| Er level 1 (99281) range across 4 matching MRF lines |
$98.44–$189.75 | $131.25–$253 | varies |
| Er level v (99285) range across 3 matching MRF lines |
$338.63–$1,376.25 | $451.50–$1,835 | varies |
| Evaluate pt use of inhaler (94664) | $288 | $384 | 1.3× |
| Evaluate Swallowing Function (92610) range across 3 matching MRF lines |
$187.50–$606.38 | $250–$808.50 | varies |
| External ECG rec>48hr<7d recording (93242) | $547.50 | $730 | 14.6× |
| Extracranial Bilat Study (93880) range across 2 matching MRF lines |
$472.50–$543.38 | $630–$724.50 | varies |
| Holter monitor recording (93225) range across 2 matching MRF lines |
$488.25–$1,102.50 | $651–$1,470 | varies |
| Immunization administration (90471) range across 5 matching MRF lines |
$95.25–$150.75 | $127–$201 | varies |
| Iontophoresis 15 min (97033) range across 4 matching MRF lines |
$181.13–$189 | $241.50–$252 | varies |
| Irrig Drug Delivery Device (96523) range across 2 matching MRF lines |
$85.50–$94.50 | $114–$126 | varies |
| IV infusion hydration each additional hour (96361) range across 4 matching MRF lines |
$36.19–$102.38 | $48.25–$136.50 | varies |
| IV infusion hydration initial 31 min-1 hour (96360) range across 4 matching MRF lines |
$126–$459.75 | $168–$613 | varies |
| IV infusion ther proph addl sequential to 1 hr (96367) range across 4 matching MRF lines |
$74.81–$150.75 | $99.75–$201 | varies |
| IV infusion therapy prophylaxis/dx ea hour (96366) range across 3 matching MRF lines |
$61.50–$102 | $82–$136 | varies |
| IV push initial (96374) range across 3 matching MRF lines |
$313.50–$459.75 | $418–$613 | varies |
| Lung Function Test (Mbc/Mvv) (94200) | $85.50 | $114 | 1.4× |
| Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) | $11.81 | $15.75 | 0.4× |
| Medical nutrition assmt&ivntj indiv each 15 mi (97802) range across 4 matching MRF lines |
$46.50–$48.75 | $62–$65 | varies |
| Methacholine challenge (94070) | $731.25 | $975 | 2.0× |
| Motion Fluoroscopy/Swallow (92611) | $527.63 | $703.50 | 5.8× |
| Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) | $275.25 | $367 | 1.4× |
| Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) | $529.50 | $706 | 1.3× |
| Neuromuscular Reeducation (97112) range across 12 matching MRF lines |
$98.44–$189 | $131.25–$252 | varies |
| Oral Function Therapy (92526) range across 3 matching MRF lines |
$225–$409.50 | $300–$546 | varies |
| Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) range across 4 matching MRF lines |
$173.25–$189 | $231–$252 | varies |
| Ot Contrast Bath Ea 15 Min (97034) range across 4 matching MRF lines |
$181.13–$192.94 | $241.50–$257.25 | varies |
| Ot eval high complexity (97167) | $311.06 | $414.75 | 3.1× |
| Ot Eval Low Complex (97165) | $311.06 | $414.75 | 3.1× |
| Ot Eval Moderate Complexity (97166) | $311.06 | $414.75 | 3.1× |
| Ot manual therapy 15 min (97140) range across 4 matching MRF lines |
$118.13–$126 | $157.50–$168 | varies |
| Ot paraffin bath (97018) range across 4 matching MRF lines |
$102.38–$110.25 | $136.50–$147 | varies |
| Ot Prosthetic Training, Each 15 Min (97761) range across 8 matching MRF lines |
$173.25–$189 | $231–$252 | varies |
| Ot Re-Eval Est Plan Care (97168) | $118.13 | $157.50 | 1.7× |
| Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) | $283.50 | $378 | 2.2× |
| Peripheral arterial disease rehab per session (93668) | $133.50 | $178 | 2.3× |
| Phlebotomy therapeutic (99195) range across 2 matching MRF lines |
$187.50–$228.38 | $250–$304.50 | varies |
| Phys/qhp svcs op pulm rehab w/cont oximtry mntr (94626) | $133.50 | $178 | 2.3× |
| Phys/qhp svcs op pulm rehab wo cont oximtry mntr (94625) | $133.50 | $178 | 2.3× |
| Physical Performance Test (97750) range across 7 matching MRF lines |
$33–$102.38 | $44–$136.50 | varies |
| Plethysmography (94726) | $405.75 | $541 | 1.1× |
| Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) range across 3 matching MRF lines |
$854.25–$3,193.31 | $1,139–$4,257.75 | varies |
| Psych diag eval w/med srvcs (90792) | $703.50 | $938 | 4.0× |
| Pt Eval High Complex (97163) | $322.88 | $430.50 | 3.3× |
| Pt eval low complex 20 min (97161) | $322.88 | $430.50 | 3.3× |
| Pt Eval Mod Complex (97162) | $322.88 | $430.50 | 3.3× |
| Pt gait training 15 min (97116) range across 4 matching MRF lines |
$129.94–$145.69 | $173.25–$194.25 | varies |
| Pt mechanical traction (97012) range across 4 matching MRF lines |
$90.56–$94.50 | $120.75–$126 | varies |
| Pt Re-Eval Est Plan Care (97164) | $133.88 | $178.50 | 2.0× |
| Pulmonary Stress Testing (94618) range across 2 matching MRF lines |
$74.81–$172.50 | $99.75–$230 | varies |
| Remote 30 Day Ecg Rev/Report (93270) | $173.25 | $231 | 4.6× |
| Rhythm Ecg 1-3 Leads Tracing Only W/O I&R (93041) range across 3 matching MRF lines |
$78.75–$204.75 | $105–$273 | varies |
| Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) | $275.25 | $367 | 1.4× |
| Self Care Mngment Training (97535) range across 13 matching MRF lines |
$47.25–$141.75 | $63–$189 | varies |
| Sensory Integration Ea 15 Min (97533) | $149.63 | $199.50 | 2.5× |
| Sleep study attended (95807) range across 2 matching MRF lines |
$531–$825 | $708–$1,100 | varies |
| Sleep study unattended (95806) range across 2 matching MRF lines |
$130.50–$419.25 | $174–$559 | varies |
| Slp Stdy Unatnd W/Anal (95801) range across 2 matching MRF lines |
$129–$300 | $172–$400 | varies |
| Slp Stdy Unatnd W/Hrt Rate/O2 Sat/Resp/Slp Time (95800) range across 2 matching MRF lines |
$226.50–$332.25 | $302–$443 | varies |
| Speech sound lang comprehen (92523) range across 2 matching MRF lines |
$204.75–$562.50 | $273–$750 | varies |
| Spirometry (94010) | $213.75 | $285 | 1.0× |
| Standardized Cognitive Performance Testing (96125) | $247.88 | $330.50 | 2.4× |
| Temp transcutaneous pacing (92953) | $866.25 | $1,155 | 1.3× |
| Ther Ivntj Ea Addl 15 Min (97130) | $52.50 | $70 | 2.5× |
| Ther Px 1/> Areas Each 15 Minutes Massage (97124) | $94.50 | $126 | 3.2× |
| Ther/Proph/Diag Inj Ia (96373) range across 3 matching MRF lines |
$181.13–$459.75 | $241.50–$613 | varies |
| Ther/Proph/Diag Inj Sc/Im (96372) range across 5 matching MRF lines |
$40.13–$150.75 | $53.50–$201 | varies |
| Ther/Proph/Diag Iv Inf Init (96365) range across 4 matching MRF lines |
$313.50–$459.75 | $418–$613 | varies |
| Therapeutic Activities (97530) range across 6 matching MRF lines |
$47.25–$102.38 | $63–$136.50 | varies |
| Tte w/doppler, complete (93306) range across 2 matching MRF lines |
$146.25–$1,697.06 | $195–$2,262.75 | varies |
| Tte W/O Doppler Complete (93307) range across 2 matching MRF lines |
$352.50–$988.31 | $470–$1,317.75 | varies |
| Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) range across 3 matching MRF lines |
$206.25–$409.50 | $275–$546 | varies |
| Tx Speech Language Voice Commj Auditry 2/>Indiv (92508) | $216.56 | $288.75 | 9.0× |
| Tx/Pro/Dx Inj New Drug Addon (96375) range across 4 matching MRF lines |
$39.38–$106.31 | $52.50–$141.75 | varies |
| Vasopneumatic device (97016) | $98.44 | $131.25 | 8.2× |
| Vent Mgmt Inpat Init Day (94002) | $948.94 | $1,265.25 | 1.5× |
| Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) | $756 | $1,008 | 1.2× |
| Wheelchair Mgmt Ea 15 Min (97542) range across 4 matching MRF lines |
$145.69–$149.63 | $194.25–$199.50 | varies |
| Whirlpool Therapy (97022) range across 4 matching MRF lines |
$102.38–$133.88 | $136.50–$178.50 | varies |
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.