Visits & medical services prices at San Luis Valley Health Conejos County Hospital

La Jara, CO · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Airway inhalation treatment (94640) $106.15 $193 0.5×
Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes Other Outpatient (97032) $58.85 $107
Application of a modality to 1 or more areas; ultrasound, each 15 minutes Other Outpatient (97035) $44 $80
Application of a modality to 1 or more areas; vasopneumatic devices Other Outpatient (97016) $29.70 $54
Bipap initial day (94660) $921.25 $1,675 4.0×
Canalith repositioning (95992) $50.60 $92
Color/duplex Doppler, complete (93975) $689.70 $1,254 2.7×
Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour (94644) $113.85 $207 0.8×
Critical care ill/injured patient init 30-74 min (99291) $1,488.30 $2,706 1.7×
Duplex scan of extracranial arteries; complete bilateral study Age Under 21 (93880) $481.80 $876 1.9×
Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study Age… (93970) $573.65 $1,043 2.3×
Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study Age… (93971) $349.80 $636 3.2×
ECG monit/reprt up to 48 hrs (93226) $168.30 $306 2.7×
EKG 12 lead tracing only (93005) $146.85 $267 2.4×
Emergency department visit high mdm (99285) $940.50 $1,710 1.5×
Emergency department visit low mdm (99283) $343.75 $625 1.2×
Emergency department visit may not req phys/qhp (99281) $71.50 $130 0.8×
Emergency department visit moderate mdm (99284) $605.55 $1,101 1.4×
Emergency department visit straightforward mdm (99282) $208.45 $379 1.3×
Eval of Oral and Pharyngeal Swallowing - Eval of Oral and Pharyngeal Swallowing Fx Chg (92610) $260.15 $473
Evaluate pt use of inhaler (94664) $80.30 $146 0.3×
Imm admn sarscov2 vaccine single dose (90480) $24.75 $45 0.6×
Immunization administration (90471) $26.95 $49 0.4×
Injection,Therap/Proph/Diagnost, IV Push, Ea Add, New Drug (96375) $102.85 $187 2.1×
Injection,Therap/Proph/Diagnost, IV Push, Initial Drug (96374) $276.65 $503 1.2×
Irrigaj implntd venous access drug delivery syst (96523) $96.80 $176 1.6×
IV infusion hydration each additional hour (96361) $68.20 $124 1.4×
IV infusion hydration initial 31 min-1 hour (96360) $197.45 $359 0.9×
IV infusion ther proph addl sequential to 1 hr (96367) $102.85 $187 1.4×
IV infusion therapy/prophylaxis /dx 1st to 1 hr (96365) $362.72 $659.50 1.6×
IV tx, each additional hour (96366) $70.95 $129 1.4×
Mechanical traction therapy (97012) $39.60 $72
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $55.55 $101
Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes… (97803) $42.90 $78
Noninvasive ear/pulse oximetry overnight monitor (94762) $184.25 $335 1.4×
Occupational therapy eval high complex 60 mins (97167) $131.45 $239
Occupational therapy eval low complex 30 mins (97165) $163.90 $298
Occupational therapy eval mod complex 45 mins (97166) $163.90 $298
Oral function therapy (92526) $144.65 $263
Osteopath manj 1-2 regions (98925) $15.40 $28 0.7×
Ot manual therapy ea 15 min (97140) $111.65 $203
Ot neuromuscular re-education (97112) $80.85 $147
OT Therapeutic Activities Charges (97530) $64.90 $118
Phlebotomy therapeutic (99195) $171.05 $311 1.2×
Physical therapy evaluation high complex 45 mins (97163) $169.40 $308
Physical therapy evaluation low complex 20 mins (97161) $169.95 $309
Physical therapy evaluation mod complex 30 mins (97162) $169.40 $308
Polysom 6/>yrs sleep w/cpap 4/> addl param attnd (95811) $1,940.95 $3,529 2.1×
Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a… (95782) $2,185.15 $3,973 2.4×
Pt gait training 15 min (97116) $52.80 $96
Pt re-evaluation (97164) $92.40 $168
Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation,… (97535) $58.85 $107
Standardized cognitive performance testing (96125) $188.10 $342
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement… (97124) $42.90 $78
Therapeutic prophylactic/dx injection subq/im (96372) $95.70 $174 1.3×
Unlisted modality (specify type and time if constant attendance) (97039) $50.60 $92