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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ProcedureCash priceGross charge× Medicare
Airway inhalation treatment (94640) $187.50 $250 0.9×
Ambulatory Bp Analysis (93788) $172.50 $230 1.3×
Ambulatory Bp Recording (93786) $224.44 $299.25 1.7×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $405.75 $541 1.1×
Cardiac Stress Tst,Tracing Only (93017) $677.25 $903 3.1×
Cardiopulmonary resuscitation (92950) $587.25 $783 2.7×
Cardioversion (92960) $561.38 $748.50 0.8×
Cbt 1st hour (94644) $172.50 $230 1.3×
Chemother,Non-Hormone Anti-Neopl, Sub-Q/Im (96401) $192.94 $257.25 2.7×
Cpap initiation and management (94660) $288 $384 1.3×
Cpt initial (94667) $172.50 $230 1.3×
Critical care (99291) $567 $756 0.7×
Debridement Open Wound 20 Sq Cm< (97597) $275.25 $367 1.4×
Demo &/or eval,pt use,aerosol device (94664) $288 $384 1.3×
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 Uxtr Art/Artl Bpgs Compl Bi Study (93930) $1,082.81 $1,443.75 4.5×
Dup-Scan Uxtr Art/Artl Bpgs Uni/Lmtd Study (93931) $543.38 $724.50 5.2×
Dup-scan xtr veins unilateral/limited study (93971) $543.38 $724.50 5.2×
Duplex scan extracranial art compl bi study (93880) $507.94 $677.25 2.1×
EKG (93005) $192.94 $257.25 3.3×
EKG rhythm strip (93041) $85.50 $114 1.4×
Electroencephalogram Extend Monitoring 41-60 Min (95812) $405.75 $541 1.9×
Er level 1 (99281) $144.10 $192.12 1.7×
Er level ii (99282) $247.97 $330.62 1.6×
Er level iii (99283) $173.25 $231 0.6×
Er level IV (99284) $275.63 $367.50 0.7×
Er level v (99285) $338.63 $451.50 0.6×
Evaluation of swallowing function (92610) $225 $300 2.7×
External ECG rec>48hr<7d recording (93242) $547.50 $730 14.6×
Holter Monitor Recording (93225) $795.38 $1,060.50 6.0×
Immunization Admin (90471) $95.25 $127 1.3×
Injection intra arterial (96373) $313.50 $418 1.5×
Irrigaj Implntd Venous Access Drug Delivery Syst (96523) $90 $120 1.5×
IV infusion hydration each additional hour (96361) $102.19 $136.25 2.2×
IV infusion hydration initial 31 min-1 hour (96360) $313.50 $418 1.5×
IV infusion, therap/proph/diagnost,add infusion,1st hour (96367) $150.75 $201 2.1×
IV infusion, therap/proph/diagnost,initial,1st hour (96365) $313.50 $418 1.5×
IV infusion, therap/proph/diagnost,initial,ea add hour (96366) $101.25 $135 2.2×
IV push initial (96374) $313.50 $418 1.5×
Manual therapy 15 min (97140) $122.06 $162.75 4.4×
Massage 15 min (97124) $94.50 $126 3.2×
Maximum voluntary ventilation (94200) $85.50 $114 1.4×
Mechanical traction (97012) $92.53 $123.38 6.4×
Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) $11.81 $15.75 0.4×
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $48.75 $65 1.3×
Methacholine challenge (94070) $731.25 $975 2.0×
Motion Fluor Eval Swlng Funcj C/V Rec (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×
Noninvasive Ear/Pulse Oximetry Overnight Monitor (94762) $213.75 $285 1.7×
Orthotics mgmt & traing initial enctr ea 15 mins (97760) $181.12 $241.50 3.9×
Ot Community/Work Reintegration Trainj Ea 15 Min (97537) $141.75 $189 4.4×
Ot Contrast Bath Ea 15 Min (97034) $187.04 $249.38 13.3×
Ot eval high complex 60 min (97167) $311.06 $414.75 3.1×
Ot eval low complex 30 min (97165) $311.06 $414.75 3.1×
Ot eval mod complex 45 min (97166) $311.06 $414.75 3.1×
Ot Prosthetic Training, Each 15 Min (97761) $181.12 $241.50 4.5×
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×
Paraffin bath (97018) $106.32 $141.75 17.7×
Peripheral arterial disease rehab per session (93668) $133.50 $178 2.3×
Phy/qhp op pulm rhb w/mntr (94626) $133.50 $178 2.3×
Phy/qhp op pulm rhb w/o mntr (94625) $133.50 $178 2.3×
Plethysmography (94726) $405.75 $541 1.1×
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $3,193.31 $4,257.75 3.7×
Psych diag eval w/med srvcs (90792) $703.50 $938 4.0×
Pt Electric Current Therapy (97033) $185.06 $246.75 9.7×
Pt Electrical Stimulation (97032) $131.91 $175.88 9.0×
Pt eval high complex 45 min (97163) $322.88 $430.50 3.3×
Pt eval low complex 20 min (97161) $322.88 $430.50 3.3×
Pt Gait Training Therapy (97116) $137.82 $183.75 4.7×
Pt Neuromusc Reeducat,1+ Areas, Ea 15 Min (97112) $189 $252 5.8×
Pt Physical Performance Test (97750) $97.50 $130 2.9×
Pt Physical Therapy Evaluation Mod Complex 30 Mins (97162) $322.88 $430.50 3.3×
Pt re-evaluation (97164) $133.88 $178.50 2.0×
Pt Self-Care/Home Mgmt Training Each 15 Minutes (97535) $47.25 $63 1.5×
Pt Ultrasound Therapy (97035) $98.44 $131.25 6.9×
Pt Whirlpool Therapy (97022) $114.19 $152.25 7.3×
Pulmonary stress testing (94618) $123.66 $164.88 0.9×
Remote 30 Day Ecg Rev/Report - Cardiac Event Monitor (93270) $173.25 $231 4.6×
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) $275.25 $367 1.4×
Rt Chest Wall Manipulation,Subsequent (94668) $112.50 $150 0.8×
Sensory Integration Ea 15 Min (97533) $149.63 $199.50 2.5×
Sleep study attended (95807) $678 $904 1.8×
Sleep study unattended (95806) $274.88 $366.50 1.3×
Slp Stdy Unatnd W/Hrt Rate/O2 Sat/Resp/Slp Time (95800) $279.38 $372.50 1.3×
Slp stdy unatnd w/min hrt rate/o2 sat/resp anal (95801) $214.50 $286 3.6×
Speech group therapy (92508) $216.56 $288.75 9.0×
Speech sound lang comprehen (92523) $383.62 $511.50 1.7×
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 Cog Funcj Cntct Ea Addl 15 Minutes (97130) $52.50 $70 2.5×
Ther/Proph/Diag Inj Sc/Im (96372) $95.25 $127 1.3×
Therapeutic Activities (97530) $47.25 $63 1.3×
Therapeutic phlebotomy (99195) $207.94 $277.25 1.6×
Tte W/Doppler Complete - Tte Complete W/ Contrast (93306) $921.66 $1,228.88 1.7×
Tte W/O Doppler Complete - Tte Complete No Doppler No Color (93307) $670.40 $893.88 2.8×
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $206.25 $275 2.7×
Tx Swallowing Dysfunction&/Oral Funcj Feeding (92526) $262.50 $350 3.1×
Tx/Pro/Dx Inj New Drug Addon (96375) $104.16 $138.88 2.2×
Vasc Duplex Extrem Venous,Bilat (93970) $1,082.81 $1,443.75 4.5×
Vasopneumatic device (97016) $98.44 $131.25 8.2×
Ventilation assist & mgmt inpatient 1st 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) $147.66 $196.88 4.8×