Visits & medical services prices at San Luis Valley Health Regional Medical Center

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

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

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ProcedureCash priceGross charge× Medicare
Aep threshold estimation mlt frequencies i&r (92652) $394.35 $717 1.7×
Aerosol inhalation pentamidine (94642) $142.45 $259 0.6×
Airway inhalation treatment (94640) $106.15 $193 0.5×
Allergy injection single (95115) $28.60 $52 0.6×
Appl on-body injector for timed subq injection (96377) $41.25 $75 0.8×
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; iontophoresis, each 15 minutes Other Outpatient (97033) $40.70 $74
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
Application of ultraviolet light to skin (96900) $65.45 $119 1.7×
Behav assmt w/score & docd/stand instrument (96127) $3.85 $7 0.1×
Bipap initial day (94660) $921.25 $1,675 4.0×
Breathing capacity test (94010) $135.85 $247 0.6×
Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration (94060) $319.55 $581 0.8×
Canalith repositioning (95992) $50.60 $92
Cardiovascular stress test (93017) $652.30 $1,186 2.9×
Cardioversion elective external (92960) $218.35 $397 0.3×
Chemo anti-neopl sq/im (96401) $178.75 $325 2.4×
Chemo hormon antineopl sq/im (96402) $133.65 $243 1.8×
Chemo IV infus each addl seq (96417) $234.85 $427 3.1×
Chemo IV infusion addl hr (96415) $190.30 $346 2.5×
Chemo IV push addl drug (96411) $200.20 $364 2.6×
Chemother prolong infuse w/pump (96416) $568.15 $1,033 1.6×
Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug (96413) $480.42 $873.50 1.4×
Chemotherapy administration; intravenous, push technique, single or initial substance/drug (96409) $373.45 $679 1.1×
Color/duplex Doppler, complete (93975) $689.70 $1,254 2.7×
Concurrent chemotherapy (96549) $222.20 $404 4.5×
Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour (94644) $113.85 $207 0.8×
Cpr (92950) $270.05 $491 1.2×
Critical care ill/injured patient init 30-74 min (99291) $1,488.30 $2,706 1.7×
Debridement open wound 20 sq cm< (97597) $26.95 $49 0.1×
Delivery/birthing room resuscitation (99465) $572 $1,040 0.8×
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×
Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording);… (93313) $1,505.90 $2,738 2.6×
EEG awake & asleep (95819) $681.45 $1,239 3.0×
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×
Endoscopy swallow (fees) vid (92612) $112.20 $204
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×
Evaluation of speech sound production articulate (92522) $207.90 $378
External ECG rec>7d<15d recording (93246) $138.05 $251 3.5×
External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes… (93225) $348.15 $633 2.5×
Gas dilut/washout lung vol w/wo distrib vent&vol (94727) $135.85 $247 0.6×
Imm admn sarscov2 vaccine single dose (90480) $24.75 $45 0.6×
Immunization administration (90471) $26.95 $49 0.4×
Infrared therapy (97026) $25.85 $47
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
Motion fluoroscopic evaluation of swallowing function by cine or video recording Other Outpatient (92611) $234.02 $425.50
Negative pressure wound therapy dme </= 50 sq cm (97605) $175.45 $319 0.8×
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
Ot manual therapy ea 15 min (97140) $111.65 $203
Ot neuromuscular re-education (97112) $80.85 $147
Ot paraffin bath (97018) $25.85 $47
Ot re-evaluation (97168) $88.55 $161
OT Therapeutic Activities Charges (97530) $64.90 $118
Outpatient cardiac rehab w/cont ECG monitoring (93798) $165 $300 1.2×
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) $152.90 $278
Physical therapy evaluation mod complex 30 mins (97162) $169.68 $308.50
Polysom 6/>yrs sleep w/cpap 4/> addl param attnd (95811) $1,940.95 $3,529 2.1×
Prepj& allergen immunotherapy 1/mlt antigen (95165) $6.60 $12 0.1×
Professional services for allergen immunotherapy; 2 or more injections (95117) $28.05 $51 0.6×
Pt gait training 15 min (97116) $52.80 $96
Pt re-evaluation (97164) $92.40 $168
Pt-focused hlth risk assmt score doc stnd instrm (96160) $26.40 $48 0.7×
Pulmonary stress testing (94618) $48.40 $88 0.3×
Refill/maint pump/resvr syst (96522) $215.60 $392 1.0×
Refilling and maintenance of portable pump (96521) $350.90 $638 1.6×
Remote 30 day ECG rev/report (93270) $290.40 $528 7.4×
Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation,… (97535) $58.85 $107
Sleep study unattended (95806) $72.60 $132 0.3×
Speech sound lang comprehen (92523) $260.15 $473
Standardized cognitive performance testing (96125) $169.95 $309
Stress tte only (93350) $1,208.35 $2,197 2.1×
Telephone assmt&mgmt svc nqhp est pt 11-20 min (98967) $38.50 $70
Telephone assmt&mgmt svc nqhp est pt 21-30 min (98968) $59.95 $109
Telephone assmt&mgmt svc nqhp est pt 5-10 min (98966) $19.80 $36
Test for hearing various pitches using earphone (92552) $113.85 $207 0.8×
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $52.25 $95
Ther ivntj cog funcj cntct ea addl 15 minutes (97130) $52.25 $95
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×
Tobacco use cessation intermediate 3-10 minutes (99406) $13.20 $24 0.3×
Tte f-up or lmtd (93308) $570.90 $1,038 2.3×
Tte w/doppler complete (93306) $1,383.80 $2,516 2.4×
Tx of Speech/Lang/Voice/Comm/Auditory Chg (92507) $144.65 $263
Tympanometry (92567) $59.95 $109 1.5×
Unlisted allergy/clinical immunologic service or procedure (95199) $10.45 $19 0.3×
Upr/l xtremity art 2 levels (93922) $287.10 $522 2.0×
Ventilation ip/obs initial day (94002) $1,208.35 $2,197 1.9×
Ventilator subsequent day (94003) $974.60 $1,772 1.5×