Visits & medical services prices at South Lincoln Medical Center

Kemmerer, WY · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Administration of chemotherapy into artery using push technique (96420) $81.60 $108.80 0.2×
Administration of chemotherapy into fluid-filled space between the tissue that cover the brain and spinal cord (96450) $142.28 $189.70 0.4×
Advance care planning first 30 mins (99497) $292.95 $390.60 2.8×
Airway inhalation treatment (94640) $308.30 $411.06 1.4×
Allergy injection single (95115) $18.11 $24.15 0.4×
Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes Other Outpatient (97032) $60.84 $81.12
Application of a modality to 1 or more areas; iontophoresis, each 15 minutes Other Outpatient (97033) $72.23 $96.30
Application of a modality to 1 or more areas; ultrasound, each 15 minutes Other Outpatient (97035) $59.28 $79.04
Application of a modality to 1 or more areas; vasopneumatic devices Other Outpatient (97016) $31.94 $42.59
Assistive technology assessment (eg, to restore, augment or compensate for existing function, optimize functional tasks… (97755) $95.82 $127.76
Behav assmt w/score & docd/stand instrument (96127) $11.03 $14.70 0.3×
Bipap initial day (94660) $540.54 $720.72 2.4×
Breathing capacity test (94010) $309.35 $412.46 1.4×
Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration (94060) $328.54 $438.06 0.9×
Canalith repositioning (95992) $108.42 $144.56
Cardioversion elective external (92960) $316.13 $421.51 0.5×
Caregiver training 1st 30 min (97550) $84 $112
Chemo anti-neopl sq/im (96401) $57.66 $76.88 0.8×
Chemo hormon antineopl sq/im (96402) $24.87 $33.16 0.3×
Chemo intralesional over 7 (96406) $88.59 $118.12 0.4×
Chemo intralesional up to 7 (96405) $63.44 $84.59 0.9×
Chemo IV infus each addl seq (96417) $48.41 $64.54 0.7×
Chemo IV infusion addl hr (96415) $21.80 $29.07 0.3×
Chemo IV push addl drug (96411) $47.84 $63.79 0.7×
Chemother prolong infuse w/pump (96416) $108.57 $144.76 0.3×
Chemotherapy administration into pleural cavity, requiring and including thoracentesis (96440) $668.24 $890.98 2.0×
Chemotherapy administration into the peritoneal cavity via implanted port or catheter (96446) $150.92 $201.23 0.4×
Chemotherapy administration, intra-arterial; infusion technique, each additional hour (List separately in addition to… (96423) $60.45 $80.60 1.3×
Chemotherapy administration, intra-arterial; infusion technique, initiation of prolonged infusion (more than 8 hours),… (96425) $141.09 $188.12 0.4×
Chemotherapy administration, intra-arterial; infusion technique, up to 1 hour (96422) $130.92 $174.56 0.4×
Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug (96413) $103.98 $138.64 0.3×
Chemotherapy administration; intravenous, push technique, single or initial substance/drug (96409) $85.04 $113.38 0.3×
Chemotherapy injection, subarachnoid or intraventricular via subcutaneous reservoir, single or multiple agents (96542) $92.49 $123.32 0.3×
Chron care mgmt srvc 20 min (99490) $346.50 $462 3.3×
Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or… (97537) $82.72 $110.29
Complex chronic care management services for two or more chronic conditions, first 60 minutes of clinical staff time… (99487) $98.74 $131.65 0.5×
Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour (94644) $496.08 $661.44 3.6×
Cpr (92950) $562.24 $749.66 2.5×
Critical care ill/injured patient init 30-74 min (99291) $630.63 $840.84 0.7×
Debridement open wound 20 sq cm< (97597) $212.78 $283.71 1.0×
Delivery/birthing room resuscitation (99465) $865.72 $1,154.30 1.3×
Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study Age… (93970) $930.13 $1,240.18 3.8×
Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study Age… (93971) $508.70 $678.27 4.8×
ECG monit/reprt up to 48 hrs (93226) $262.08 $349.44 4.3×
EKG 12 lead tracing only (93005) $208.26 $277.68 3.5×
Emergency department visit high mdm (99285) $821.62 $1,095.48 1.4×
Emergency department visit low mdm (99283) $215.14 $286.84 0.8×
Emergency department visit may not req phys/qhp (99281) $48.32 $64.43 0.6×
Emergency department visit moderate mdm (99284) $272.87 $363.83 0.6×
Emergency department visit straightforward mdm (99282) $94.64 $126.18 0.6×
End tidal co2 mntrng (crbn dxde exp gas dtrmntn by infrared analyzer) (94799) $368.16 $490.88 2.8×
Eval of Oral and Pharyngeal Swallowing - Eval of Oral and Pharyngeal Swallowing Fx Chg (92610) $249.60 $332.80
Evaluate pt use of inhaler (94664) $349.44 $465.92 1.6×
Evaluation of speech sound production articulate (92522) $253.50 $338
Evoked auditory test limited (92587) $219.18 $292.24 1.0×
External ECG rec>7d<15d scanning alys w/report (93247) $376.74 $502.32 2.8×
External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes… (93225) $288.60 $384.80 2.1×
Fluidotherapy (97022) $45.86 $61.15
Gas dilut/washout lung vol w/wo distrib vent&vol (94727) $409.50 $546 1.9×
Hast w/oxygen titrate (94453) $98.28 $131.04 0.7×
Hot/cold pack (97010) $8.19 $10.92
Im adm intransl/oral 1 vaccine (90473) $19.58 $26.10 0.3×
Immunization administration (90471) $48.87 $65.16 0.7×
Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant (99460) $226.86 $302.48 1.7×
Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant admitted and… (99463) $198.20 $264.26 1.5×
Injection,Therap/Proph/Diagnost, IV Push, Ea Add, New Drug (96375) $83.94 $111.92 1.8×
Injection,Therap/Proph/Diagnost, IV Push, Initial Drug (96374) $146.62 $195.50 0.7×
Intracutaneous (intradermal) tests, sequential and incremental, with allergenic extracts for airborne allergens,… (95027) $12.29 $16.38 0.4×
IV infusion hydration each additional hour (96361) $186.46 $248.60 3.9×
IV infusion hydration initial 31 min-1 hour (96360) $131.86 $175.81 0.6×
IV infusion ther proph addl sequential to 1 hr (96367) $118.60 $158.12 1.6×
IV infusion therapy/prophylaxis /dx 1st to 1 hr (96365) $174.25 $232.33 0.8×
IV tx, each additional hour (96366) $110.76 $147.68 2.3×
Low frequency non-thermal us (97610) $565.93 $754.57 2.8×
Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent (94668) $270.66 $360.88 2.0×
Maximum voluntary ventilation (94200) $262.08 $349.44 4.3×
Mechanical chest wall oscillation lung function (94669) $511.88 $682.50 2.3×
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $79.44 $105.92
Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes… (97803) $38.91 $51.88
Neg pressure wound therapy non dme </= 50 sq cm (97607) $515.97 $687.96 1.2×
Neg pressure wound therapy non dme >50 sq cm (97608) $515.97 $687.96 1.2×
Negative pressure wound therapy dme </= 50 sq cm (97605) $429.16 $572.21 2.1×
Negative pressure wound therapy dme >50 sq cm (97606) $784.61 $1,046.14 1.9×
Noninvasive ear/pulse oximetry overnight monitor (94762) $363.48 $484.64 2.8×
Occupational therapy eval high complex 60 mins (97167) $287.82 $383.76
Occupational therapy eval low complex 30 mins (97165) $230.10 $306.80
Occupational therapy eval mod complex 45 mins (97166) $290.94 $387.92
Oral function therapy (92526) $216.22 $288.29
Orthc/prostc mgmt sbsq enc (97763) $126.95 $169.26
Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper… (97760) $119.57 $159.43
Osteopath manj 1-2 regions (98925) $50.77 $67.69 2.3×
Osteopath manj 3-4 regions (98926) $71.25 $95 3.2×
Ot manual therapy ea 15 min (97140) $99.84 $133.12
Ot neuromuscular re-education (97112) $101.79 $135.72
Ot paraffin bath (97018) $35.22 $46.96
Ot re-evaluation (97168) $156.43 $208.57
OT Therapeutic Activities Charges (97530) $99.92 $133.22
Ot wheelchair management (97542) $80.68 $107.56
Oxygen uptake, expired gas analysis; including CO2 output, percentage oxygen extracted (94681) $297.18 $396.24 0.8×
Phlebotomy therapeutic (99195) $208.26 $277.68 1.5×
Physical therapy evaluation high complex 45 mins (97163) $256.62 $342.16
Physical therapy evaluation low complex 20 mins (97161) $195.74 $260.99
Physical therapy evaluation mod complex 30 mins (97162) $269.10 $358.80
Prepj& allergen immunotherapy 1/mlt antigen (95165) $13.10 $17.47 0.3×
Prepj& antigen allergen immunotherapy 1 insect (95145) $17.06 $22.74 0.4×
Professional services for allergen immunotherapy; 2 or more injections (95117) $21.29 $28.39 0.4×
Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify… (95149) $54.68 $72.90 0.7×
Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify… (95146) $30.44 $40.58 0.6×
Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify… (95148) $41.02 $54.69 0.6×
Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy, single… (95144) $9.82 $13.09 0.2×
Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; whole… (95170) $7.59 $10.12 0.2×
Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes Other… (97761) $103.19 $137.59
Pt gait training 15 min (97116) $99.06 $132.08
Pt physical performance test (97750) $87.63 $116.84
Pt re-evaluation (97164) $173.94 $231.92
Pt Work Hardening/conditioningwork Reconditioning Initial Charge (97545) $491.40 $655.20
Pulm funct tst plethysmograp (94726) $682.50 $910 1.8×
Pulmonary stress testing (94618) $86.37 $115.16 0.6×
Refilling and maintenance of portable pump (96521) $105.37 $140.49 0.5×
Respiratory flow volume loop (94375) $682.50 $910 3.1×
Review patient spirometry (94016) $44.23 $58.97
Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation,… (97535) $103.45 $137.93
Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands,… (97533) $108.24 $144.32
Sleep study unattended (95806) $128.58 $171.44 0.6×
Subcut infusion, therap/proph/diagnost,ea add hour (96370) $12.05 $16.07 0.3×
Subcut infusion, therap/proph/diagnost,initial,1st hour (96369) $151.78 $202.37 0.7×
Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); additional pump set-up with establishment… (96371) $70.85 $94.46 1.0×
Surfactant administration (94610) $470.93 $627.90 2.1×
Temp transcutaneous pacing (92953) $716.04 $954.72 1.1×
Test to measure resistance of the airways and lungs to differing frequencies (94728) $619.98 $826.64 4.7×
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $77.81 $103.74
Ther/proph/diag inj ia (96373) $15.11 $20.14 0.1×
Therapeutic procedure(s), group (2 or more individuals) Other Outpatient (97150) $46.68 $62.24
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement… (97124) $77.81 $103.74
Therapeutic prophylactic/dx injection subq/im (96372) $45.48 $60.64 0.6×
Tobacco use cessation intensive >10 minutes (99407) $72.81 $97.08 1.9×
Tobacco use cessation intermediate 3-10 minutes (99406) $29.14 $38.85 0.8×
Trans care mgmt 14 day disch (99495) $128.47 $171.29 0.9×
Trans care mgmt 7 day disch (99496) $181.52 $242.03 1.3×
Tte f-up or lmtd (93308) $407.46 $543.28 1.7×
Tx of Speech/Lang/Voice/Comm/Auditory Chg (92507) $217.62 $290.16
Ventilation ip/obs initial day (94002) $1,352.32 $1,803.10 2.1×
Ventilator subsequent day (94003) $1,059.38 $1,412.50 1.7×
Vital capacity total (94150) $274.33 $365.77 2.1×
Work hardening/conditioning; each additional hour (List separately in addition to code for primary procedure) (97546) $311.22 $414.96
Wound(s) care non-selective (97602) $141.18 $188.24 0.7×