Visits & medical services prices at Southwest Memorial Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Airway inhalation treatment (94640) $302 $603 1.3×
Allergy injection single (95115) $63 $125 1.3×
Anogenital examination, magnified, in childhood for suspected trauma, including image recording when performed (99170) $228 $456 1.1×
Application of a modality to 1 or more areas; contrast baths, each 15 minutes Other Outpatient (97034) $23 $45
Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes Other Outpatient (97032) $23 $45
Application of a modality to 1 or more areas; ultrasound, each 15 minutes Other Outpatient (97035) $22 $43
Assessment of aphasia (96105) $131 $261
Behavioral & qualit analysis voice and resonance (92524) $143 $286
Bipap initial day (94660) $331 $661 1.4×
Breathing capacity test (94010) $171 $341 0.8×
Bronchial allergy tests (95070) $499 $997 1.3×
Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration (94060) $367.50 $735 0.9×
Canalith repositioning (95992) $73 $145
Car seat/bed test inft thru 12 mo 60 min (94780) $45 $90 1.1×
Cardiovascular stress test (93017) $561 $1,122 2.5×
Cardioversion elective external (92960) $1,023 $2,045 1.5×
Chemo anti-neopl sq/im (96401) $216 $432 2.8×
Chemo hormon antineopl sq/im (96402) $216 $432 2.8×
Chemo IV infus each addl seq (96417) $268 $535 3.5×
Chemo IV infusion addl hr (96415) $148 $295 1.9×
Chemo IV push addl drug (96411) $224 $447 2.9×
Chemother prolong infuse w/pump (96416) $594 $1,187 1.7×
Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug (96413) $594 $1,187 1.7×
Chemotherapy administration; intravenous, push technique, single or initial substance/drug (96409) $390 $779 1.1×
Chest physiotherapy initial (94667) $118 $235 0.8×
Color/duplex Doppler, limited (93976) $569 $1,137 5.2×
Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or… (97537) $36 $72
Cont gluc mntr physician/qhp provided equipment (95250) $112 $224 0.8×
Cont gluc mntr pt prov eqp (95249) $97 $193 1.6×
Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour (94644) $205 $409 1.5×
Cpr (92950) $531.50 $1,063 2.3×
Critical care ill/injured patient init 30-74 min (99291) $1,115 $2,230 1.3×
Debridement open wound 20 sq cm< (97597) $115 $229 0.5×
Duplex hemodialysis access (93990) $550 $1,099 5.0×
Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; unilateral or limited study Age Under 21 (93979) $444 $888 4.0×
Duplex scan of extracranial arteries; complete bilateral study Age Under 21 (93880) $692 $1,383 2.7×
Duplex scan of extracranial arteries; unilateral or limited study Age Under 21 (93882) $453 $906 4.1×
Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study Age… (93970) $840 $1,680 3.3×
Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study Age… (93971) $560 $1,119 5.1×
Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93925) $851 $1,702 3.4×
Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93926) $534 $1,068 4.8×
Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93930) $713 $1,426 2.8×
Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93931) $540 $1,080 4.9×
ECG/monitoring and analysis (93271) $140 $279 1.4×
EKG 12 lead tracing only (93005) $157 $313.50 2.5×
Emergency department visit high mdm (99285) $844.50 $1,688.50 1.3×
Emergency department visit low mdm (99283) $338.50 $677 1.2×
Emergency department visit may not req phys/qhp (99281) $174 $348 2.0×
Emergency department visit moderate mdm (99284) $515.50 $1,030.50 1.2×
Emergency department visit straightforward mdm (99282) $131 $262 0.8×
Endoscopy swallow (fees) vid (92612) $87 $174
Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and… (91010) $653 $1,306 1.7×
Eval of Oral and Pharyngeal Swallowing - Eval of Oral and Pharyngeal Swallowing Fx Chg (92610) $116 $231
Evaluate pt use of inhaler (94664) $209 $418 0.9×
Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with… (92608) $63 $126
Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with… (92607) $154 $307
Evaluation of speech fluency (92521) $135 $269
Evaluation of speech sound production articulate (92522) $112 $224
External ECG rec>48hr<7d recording (93242) $192.50 $384.50 4.9×
External ECG rec>7d<15d recording (93246) $407 $814 10.3×
External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes… (93225) $337 $673 2.4×
Fluidotherapy (97022) $29 $57
Gas dilut/washout lung vol w/wo distrib vent&vol (94727) $287.50 $574.50 1.3×
Hot/cold pack (97010) $9 $17
Imm admn sarscov2 vaccine single dose (90480) $89 $177 2.1×
Immunization administration (90471) $43 $86 0.6×
Injection,Therap/Proph/Diagnost, IV Push, Ea Add, New Drug (96375) $109 $218 2.2×
Injection,Therap/Proph/Diagnost, IV Push, Initial Drug (96374) $149 $297 0.7×
Irrigaj implntd venous access drug delivery syst (96523) $92 $184 1.5×
IV infusion hydration each additional hour (96361) $71 $141 1.4×
IV infusion hydration initial 31 min-1 hour (96360) $357 $714 1.6×
IV infusion ther proph addl sequential to 1 hr (96367) $144 $287.50 1.9×
IV infusion therapy/prophylaxis /dx 1st to 1 hr (96365) $430.50 $860 1.9×
IV tx, each additional hour (96366) $108 $216 2.2×
Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent (94668) $163 $326 1.2×
Mechanical chest wall oscillation lung function (94669) $209 $418 0.9×
Mechanical traction therapy (97012) $20 $40
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $27 $54
Medical nutrition group (97804) $14 $27
Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes… (97803) $24 $48
Methacholine challenge (94070) $1,141 $2,281 2.9×
Motion fluoroscopic evaluation of swallowing function by cine or video recording Other Outpatient (92611) $141 $281
Multiple sleep latency (95805) $903 $1,805 1.0×
Nasopharyngoscopy (92511) $70 $140 0.3×
Neg pressure wound therapy non dme </= 50 sq cm (97607) $422 $844 1.0×
Neg pressure wound therapy non dme >50 sq cm (97608) $422 $844 1.0×
Negative pressure wound therapy dme </= 50 sq cm (97605) $250 $499 1.2×
Negative pressure wound therapy dme >50 sq cm (97606) $349 $698 0.8×
Occupational therapy eval high complex 60 mins (97167) $104 $207
Occupational therapy eval low complex 30 mins (97165) $104 $207
Occupational therapy eval mod complex 45 mins (97166) $104 $207
Oral function therapy (92526) $105 $210
Orthc/prostc mgmt sbsq enc (97763) $83 $166
Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper… (97760) $76 $151
Osteopath manj 1-2 regions (98925) $36 $71 1.6×
Ot manual therapy ea 15 min (97140) $37.50 $74
Ot neuromuscular re-education (97112) $41.50 $82
Ot paraffin bath (97018) $13 $25
Ot re-evaluation (97168) $63 $126
OT Therapeutic Activities Charges (97530) $50.50 $100
Ot wheelchair management (97542) $37 $74
Other physical medicine or rehabilitation service or procedure (97799) $55 $110
Outpatient cardiac rehab w/cont ECG monitoring (93798) $131 $262 1.0×
Phlebotomy therapeutic (99195) $99 $197 0.7×
Physical therapy evaluation high complex 45 mins (97163) $91 $182
Physical therapy evaluation low complex 20 mins (97161) $93 $186
Physical therapy evaluation mod complex 30 mins (97162) $93 $186
Polysom 6/>yrs sleep w/cpap 4/> addl param attnd (95811) $2,615 $5,229 2.9×
Pr unlisted therapeutic procedure specify (97139) $11 $22
Professional services for allergen immunotherapy; 2 or more injections (95117) $43 $86 0.9×
Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes Other… (97761) $51 $101
Psychiatric diagnostic evaluation (90791) $138 $276 0.7×
Pt gait training 15 min (97116) $35 $70
Pt physical performance test (97750) $39 $78
Pt re-evaluation (97164) $51 $102
Pt Work Hardening/conditioningwork Reconditioning Initial Charge (97545) $95 $190
Pulmonary stress testing (94618) $138 $275 1.0×
Refilling and maintenance of portable pump (96521) $264 $527 1.2×
Respiratory flow volume loop (94375) $279 $558 1.2×
Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation,… (97535) $44 $88
Sleep study unattended (95806) $409 $818 1.8×
Speech sound lang comprehen (92523) $235 $470
Standardized cognitive performance testing (96125) $147 $293
Stress tte only (93350) $1,423 $2,846 2.5×
Temp transcutaneous pacing (92953) $437.50 $875 0.6×
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $33 $66
Ther ivntj cog funcj cntct ea addl 15 minutes (97130) $33 $66
Therapeutic procedure(s), group (2 or more individuals) Other Outpatient (97150) $28 $56
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement… (97124) $32 $63
Therapeutic prophylactic/dx injection subq/im (96372) $100 $199 1.3×
Therapeutic services for the use of speech-generating device, including programming and modification Other Outpatient (92609) $134 $268
Tilt table evaluation (93660) $470 $939 1.2×
Tobacco use cessation intensive >10 minutes (99407) $52 $104 1.3×
Tte f-up or lmtd (93308) $477 $953 1.9×
Tte w/doppler complete (93306) $780 $1,559 1.4×
Tx of Speech/Lang/Voice/Comm/Auditory Chg (92507) $98 $196
Upr/l xtremity art 2 levels (93922) $251 $502 1.8×
Ventilation ip/obs initial day (94002) $1,358 $2,716 2.1×
Ventilator subsequent day (94003) $652 $1,303 1.0×
Wound(s) care non-selective (97602) $115 $229 0.5×