Visits & medical services prices at Sedgwick County Memorial Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Airway inhalation treatment (94640) $92 $92 0.4×
Allergy injection single (95115) $55 $55 1.1×
Appl modality 1+lllt po pain (97037) $79 $79 2.0×
Application of a modality to 1 or more areas; contrast baths, each 15 minutes Other Outpatient (97034) $133.50 $133.50
Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes Other Outpatient (97032) $141.50 $141.50
Application of a modality to 1 or more areas; iontophoresis, each 15 minutes Other Outpatient (97033) $151 $151
Application of a modality to 1 or more areas; ultrasound, each 15 minutes Other Outpatient (97035) $133.50 $133.50
Application of a modality to 1 or more areas; vasopneumatic devices Other Outpatient (97016) $90 $90
Assessment of aphasia (96105) $331 $331
Behavioral & qualit analysis voice and resonance (92524) $331 $331
Breathing capacity test (94010) $141 $141 0.6×
Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration (94060) $250 $250 0.6×
Canalith repositioning (95992) $165 $165
Cardiovascular stress test (93017) $170 $170 0.7×
Cardioversion elective external (92960) $1,282 $1,282 1.8×
Caregiver training 1st 30 min (97550) $228 $228
Caregiver training ea addl 15 (97551) $153 $153
Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or… (97537) $154.50 $154.50
Cpr (92950) $2,053 $2,053 9.0×
Critical care ill/injured patient init 30-74 min (99291) $942 $942 1.1×
Debridement open wound 20 sq cm< (97597) $153 $153 0.7×
Duplex scan of extracranial arteries; complete bilateral study Age Under 21 (93880) $921 $921 3.7×
Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study Age… (93970) $921 $921 3.7×
Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study Age… (93971) $813 $813 7.4×
Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93925) $563.50 $563.50 2.2×
Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93926) $813 $813 7.4×
Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93930) $921 $921 3.7×
Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93931) $732 $732 6.6×
EKG 12 lead tracing only (93005) $297 $297 4.8×
EKG rhythm strip (93041) $95 $95 1.5×
Emergency department visit high mdm (99285) $640 $640 1.0×
Emergency department visit low mdm (99283) $310 $310 1.1×
Emergency department visit may not req phys/qhp (99281) $80 $80 0.9×
Emergency department visit moderate mdm (99284) $430 $430 1.0×
Emergency department visit straightforward mdm (99282) $161 $161 1.0×
Endoscopy swallow (fees) vid (92612) $306 $306
Eval of Oral and Pharyngeal Swallowing - Eval of Oral and Pharyngeal Swallowing Fx Chg (92610) $439 $439
Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with… (92608) $331 $331
Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with… (92607) $439 $439
Evaluation for prescription of non-speech-generating augmentative and alternative communication device, face-to-face… (92605) $439 $439
Evaluation for prescription of non-speech-generating augmentative and alternative communication device, face-to-face… (92618) $331 $331
Evaluation of speech fluency (92521) $439 $439
Evaluation of speech sound production articulate (92522) $439 $439
External ECG rec>48hr<7d recording (93242) $101 $101 2.6×
External ECG rec>7d<15d recording (93246) $101 $101 2.6×
Group caregiver training strategies & technique (97552) $153 $153
Hot/cold pack (97010) $141 $141
Im adm intransl/oral 1 vaccine (90473) $15 $15 0.2×
Imm admn sarscov2 vaccine single dose (90480) $33 $33 0.8×
Immunization administration (90471) $22 $22 0.3×
Injection,Therap/Proph/Diagnost, IV Push, Ea Add, New Drug (96375) $71 $71 1.4×
Injection,Therap/Proph/Diagnost, IV Push, Initial Drug (96374) $71 $71 0.3×
IV infusion hydration each additional hour (96361) $77 $77 1.6×
IV infusion hydration initial 31 min-1 hour (96360) $328 $328 1.5×
IV infusion ther proph addl sequential to 1 hr (96367) $71 $71 0.9×
IV infusion therapy/prophylaxis /dx 1st to 1 hr (96365) $328 $328 1.5×
IV tx, each additional hour (96366) $77 $77 1.6×
Mechanical traction therapy (97012) $109 $109
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $69 $69
Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes… (97803) $54 $54
Multi-family group psychotherapy - psychologist (90849) $48 $48 0.3×
Occupational therapy eval high complex 60 mins (97167) $399 $399
Occupational therapy eval low complex 30 mins (97165) $212 $212
Occupational therapy eval mod complex 45 mins (97166) $306 $306
Oral function therapy (92526) $331 $331
Orthc/prostc mgmt sbsq enc (97763) $158 $158
Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper… (97760) $161.50 $161.50
Osteopath manj 1-2 regions (98925) $82 $82 3.6×
Osteopath manj 3-4 regions (98926) $118 $118 5.2×
Osteopath manj 9-10 regions (98929) $231 $231 10.1×
Osteopathic manipulative tx 5-6 body regions (98927) $157 $157 6.9×
Osteopathic manipulative tx 7-8 body regions (98928) $197 $197 8.6×
Ot manual therapy ea 15 min (97140) $154.50 $154.50
Ot neuromuscular re-education (97112) $140 $140
Ot paraffin bath (97018) $133.50 $133.50
Ot re-evaluation (97168) $157 $157
OT Therapeutic Activities Charges (97530) $161.50 $161.50
Ot wheelchair management (97542) $155.50 $155.50
Phlebotomy therapeutic (99195) $161 $161 1.1×
Physical therapy evaluation high complex 45 mins (97163) $399 $399
Physical therapy evaluation low complex 20 mins (97161) $212 $212
Physical therapy evaluation mod complex 30 mins (97162) $306 $306
Polysom 6/>yrs sleep w/cpap 4/> addl param attnd (95811) $3,747 $3,747 4.1×
Professional services for allergen immunotherapy; 2 or more injections (95117) $80 $80 1.6×
Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes Other… (97761) $71 $71
Psych diag eval w/med srvcs (90792) $202 $202 1.1×
Psychiatric diagnostic evaluation (90791) $412 $412 2.2×
Psychoanalysis (90845) $125 $125 0.7×
Psytx crisis initial 60 min (90839) $180 $180 1.0×
Pt gait training 15 min (97116) $109 $109
Pt physical performance test (97750) $151 $151
Pt re-evaluation (97164) $157 $157
Remote 30 day ECG rev/report (93270) $101 $101 2.6×
Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation,… (97535) $158 $158
Speech sound lang comprehen (92523) $331 $331
Standardized cognitive performance testing (96125) $331 $331
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $158 $158
Ther ivntj cog funcj cntct ea addl 15 minutes (97130) $43 $43
Ther/proph/diag inj ia (96373) $228 $228 1.0×
Therapeutic procedure(s), group (2 or more individuals) Other Outpatient (97150) $42 $42
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement… (97124) $133.50 $133.50
Therapeutic prophylactic/dx injection subq/im (96372) $53.50 $53.50 0.7×
Therapeutic service(s) for the use of non-speech-generating device, including programming and modification (92606) $331 $331
Therapeutic services for the use of speech-generating device, including programming and modification Other Outpatient (92609) $331 $331
Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study Age Under 21 (93304) $743 $743 1.3×
Tte f-up or lmtd (93308) $269.50 $269.50 1.1×
Tte w/doppler complete (93306) $1,712.50 $1,712.50 3.0×
Tx of Speech/Lang/Voice/Comm/Auditory Chg (92507) $331 $331
Upr/l xtremity art 2 levels (93922) $260 $260 1.9×
Wound(s) care non-selective (97602) $138 $138 0.7×