Visits & medical services prices at St. Elizabeth Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Aerosol inhalation pentamidine (94642) $220.48 $551.18 1.0×
Airway inhalation treatment (94640) $142.10 $355.22 0.6×
Application of a modality to 1 or more areas; contrast baths, each 15 minutes Other Outpatient (97034) $21.97 $54.92
Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes Other Outpatient (97032) $171.60 $428.98
Application of a modality to 1 or more areas; iontophoresis, each 15 minutes Other Outpatient (97033) $110.84 $277.10
Application of a modality to 1 or more areas; ultrasound, each 15 minutes Other Outpatient (97035) $113.13 $282.82
Behavioral & qualit analysis voice and resonance (92524) $80.53 $201.32
Bfb training ea addl 15 min (90913) $87.13 $217.82
Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when… (90912) $128.22 $320.55
Bipap initial day (94660) $729.24 $1,823.10 3.2×
Breathing capacity test (94010) $209.29 $523.21 0.9×
Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration (94060) $294.53 $736.32 0.7×
Cardiovascular stress test (93017) $1,375.61 $3,439.02 6.0×
Cardioversion elective external (92960) $2,024.84 $5,062.09 2.9×
Caregiver training 1st 30 min (97550) $45.10 $112.74
Caregiver training ea addl 15 (97551) $20.63 $51.56
Chemo anti-neopl sq/im (96401) $328.96 $822.40 4.3×
Chemo hormon antineopl sq/im (96402) $440.20 $1,100.49 5.8×
Chemo IV infus each addl seq (96417) $575.70 $1,439.23 7.6×
Chemo IV infusion addl hr (96415) $575.70 $1,439.23 7.6×
Chemo IV push addl drug (96411) $468.83 $1,172.07 6.2×
Chemother prolong infuse w/pump (96416) $4,141.82 $10,354.55 11.9×
Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug (96413) $1,906.47 $4,766.17 5.5×
Chemotherapy administration; intravenous, push technique, single or initial substance/drug (96409) $2,303.42 $5,758.54 6.6×
Chest physiotherapy initial (94667) $142.95 $357.37 1.0×
Color/duplex Doppler, complete (93975) $921.62 $2,304.05 3.7×
Color/duplex Doppler, limited (93976) $648.02 $1,620.03 5.9×
Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour (94644) $417.94 $1,044.84 3.0×
Cpr (92950) $2,234.08 $5,585.19 9.8×
Critical care ill/injured patient init 30-74 min (99291) $2,881.90 $7,204.73 3.3×
Debridement open wound 20 sq cm< (97597) $337.47 $843.66 1.6×
Duplex scan of extracranial arteries; complete bilateral study Age Under 21 (93880) $921.62 $2,304.05 3.7×
Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study Age… (93970) $921.62 $2,304.05 3.7×
Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study Age… (93971) $648.02 $1,620.03 5.9×
Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93925) $921.62 $2,304.05 3.7×
Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93926) $648.02 $1,620.03 5.9×
Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93931) $648.02 $1,620.03 5.9×
ECG monit/reprt up to 48 hrs (93226) $207.60 $518.99 3.3×
ECG/monitoring and analysis (93271) $1,118.33 $2,795.81 11.2×
Echo transesophageal (93312) $1,872.04 $4,680.10 3.2×
EEG awake & asleep (95819) $983.45 $2,458.62 4.3×
EEG awake/drowsy (95816) $830.15 $2,075.36 3.6×
EKG 12 lead tracing only (93005) $331.21 $828.02 5.3×
EKG rhythm strip (93041) $45.61 $114.02 0.7×
Emergency department visit high mdm (99285) $2,292.46 $5,731.13 3.6×
Emergency department visit low mdm (99283) $676.58 $1,691.43 2.3×
Emergency department visit may not req phys/qhp (99281) $205.56 $513.90 2.3×
Emergency department visit moderate mdm (99284) $897.12 $2,242.78 2.0×
Emergency department visit straightforward mdm (99282) $331.48 $828.70 2.0×
Endoscopy swallow (fees) vid (92612) $227.32 $568.29
Eval of Oral and Pharyngeal Swallowing - Eval of Oral and Pharyngeal Swallowing Fx Chg (92610) $336.47 $841.16
Evaluate pt use of inhaler (94664) $311.93 $779.81 1.4×
Evaluation of speech fluency (92521) $98.12 $245.30
Evaluation of speech sound production articulate (92522) $79.62 $199.03
External ECG rec>48hr<7d recording (93242) $782.07 $1,955.16 19.8×
External ECG rec>7d<15d recording (93246) $1,446.20 $3,615.49 36.7×
External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes… (93225) $782.07 $1,955.16 5.6×
Fluidotherapy (97022) $143.20 $358
Group caregiver training strategies & technique (97552) $19.26 $48.15
Immunization administration (90471) $314.30 $785.73 4.1×
Infrared therapy (97026) $11.97 $29.92
Injection,Therap/Proph/Diagnost, IV Push, Ea Add, New Drug (96375) $291.80 $729.48 5.9×
Injection,Therap/Proph/Diagnost, IV Push, Initial Drug (96374) $292.22 $730.55 1.3×
Irrigaj implntd venous access drug delivery syst (96523) $234.73 $586.82 3.8×
IV infusion hydration each additional hour (96361) $234.69 $586.72 4.8×
IV infusion hydration initial 31 min-1 hour (96360) $312.33 $780.82 1.4×
IV infusion ther proph addl sequential to 1 hr (96367) $309.83 $774.56 4.1×
IV infusion therapy/prophylaxis /dx 1st to 1 hr (96365) $541.70 $1,354.24 2.4×
IV tx, each additional hour (96366) $340.65 $851.61 6.9×
Low frequency non-thermal us (97610) $304.72 $761.79 1.4×
Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent (94668) $96.19 $240.46 0.7×
Mechanical chest wall oscillation lung function (94669) $292.88 $732.19 1.3×
Mechanical traction therapy (97012) $67.23 $168.06
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $26.06 $65.13
Medical nutrition group (97804) $28.80 $72
Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes… (97803) $18.60 $46.50
Methacholine challenge (94070) $1,033.07 $2,582.67 2.6×
Motion fluoroscopic evaluation of swallowing function by cine or video recording Other Outpatient (92611) $403.76 $1,009.40
Multiple sleep latency (95805) $3,223.94 $8,059.84 3.6×
Negative pressure wound therapy dme </= 50 sq cm (97605) $345.74 $864.32 1.6×
Negative pressure wound therapy dme >50 sq cm (97606) $458.86 $1,147.16 1.1×
Non-invasive physiologic study extremity 3 levels (93923) $1,399.31 $3,498.26 6.1×
Noninvasive ear/pulse oximetry overnight monitor (94762) $181.46 $453.63 1.3×
Occupational therapy eval high complex 60 mins (97167) $371.54 $928.85
Occupational therapy eval low complex 30 mins (97165) $303.99 $759.97
Occupational therapy eval mod complex 45 mins (97166) $337.76 $844.39
Oral function therapy (92526) $235.02 $587.55
Orthc/prostc mgmt sbsq enc (97763) $47.92 $119.80
Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper… (97760) $143.46 $358.64
Ot manual therapy ea 15 min (97140) $115.40 $288.50
Ot neuromuscular re-education (97112) $119.95 $299.86
Ot paraffin bath (97018) $85.89 $214.72
Ot re-evaluation (97168) $228.52 $571.29
OT Therapeutic Activities Charges (97530) $102.04 $255.09
Ot wheelchair management (97542) $118.95 $297.36
Outpatient cardiac rehab w/cont ECG monitoring (93798) $229.01 $572.52 1.7×
Outpatient cardiac rehab w/o cont ECG monitor (93797) $238.55 $596.37 1.8×
Oxygen uptake, expired gas analysis; including CO2 output, percentage oxygen extracted (94681) $185.20 $463 0.5×
Phlebotomy therapeutic (99195) $94.18 $235.44 0.7×
Physical therapy evaluation high complex 45 mins (97163) $371.54 $928.85
Physical therapy evaluation low complex 20 mins (97161) $303.99 $759.97
Physical therapy evaluation mod complex 30 mins (97162) $337.76 $844.39
Polysom 6/>yrs sleep w/cpap 4/> addl param attnd (95811) $2,229.50 $5,573.73 2.5×
Psychiatric diagnostic evaluation (90791) $236 $590 1.3×
Pt gait training 15 min (97116) $76.85 $192.12
Pt re-evaluation (97164) $228.52 $571.29
Pulm funct tst plethysmograp (94726) $414.12 $1,035.30 1.1×
Pulmonary stress testing (94618) $726.46 $1,816.14 5.2×
Range of motion measurements and report (separate procedure); each extremity (excluding hand) or each trunk section… (95851) $172.79 $431.96
Range of motion measurements and report (separate procedure); hand, with or without comparison with normal side Other… (95852) $19.26 $48.15
Remote 30 day ECG rev/report (93270) $223.94 $559.84 5.7×
Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation,… (97535) $127.95 $319.86
Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands,… (97533) $183.96 $459.88
Sleep study unattended (95806) $217.03 $542.56 1.0×
Speech sound lang comprehen (92523) $135.46 $338.63
Standardized cognitive performance testing (96125) $214.12 $535.28
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $153.43 $383.57
Ther ivntj cog funcj cntct ea addl 15 minutes (97130) $153.43 $383.57
Therapeutic procedure(s), group (2 or more individuals) Other Outpatient (97150) $62.44 $156.09
Therapeutic procedure, 1 or more areas, each 15 minutes; aquatic therapy with therapeutic exercises Other Outpatient (97113) $76.34 $190.82
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement… (97124) $130.01 $325.01
Therapeutic prophylactic/dx injection subq/im (96372) $193.67 $484.17 2.5×
Tobacco use cessation intermediate 3-10 minutes (99406) $93.51 $233.77 2.4×
Tte f-up or lmtd (93308) $922 $2,304.98 3.7×
Tte w/doppler complete (93306) $1,872.04 $4,680.10 3.2×
Tx of Speech/Lang/Voice/Comm/Auditory Chg (92507) $194.68 $486.69
Upr/l xtremity art 2 levels (93922) $263.89 $659.71 1.9×
Ventilation ip/obs initial day (94002) $1,620.22 $4,050.53 2.5×
Ventilator subsequent day (94003) $708.01 $1,770.01 1.1×
Wound(s) care non-selective (97602) $133.56 $333.89 0.6×