Visits & medical services prices at Intermountain Health St. Mary's Regional Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of… (95803) $178.20
Administration of chemotherapy into artery using push technique (96420) $1,977.50
Administration of chemotherapy into fluid-filled space between the tissue that cover the brain and spinal cord (96450) $2,081.55
Advance care planning first 30 mins (99497) $264.35
Aerosol inhalation pentamidine (94642) $1,198.45
Airway inhalation treatment (94640) $347.65
Appl on-body injector for timed subq injection (96377) $269.10
Application of a modality to 1 or more areas; contrast baths, each 15 minutes Other Outpatient (97034) $212.80
Application of a modality to 1 or more areas; diathermy (eg, microwave) Other Outpatient (97024) $130.60
Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes Other Outpatient (97032) $85.25
Application of a modality to 1 or more areas; Hubbard tank, each 15 minutes Other Outpatient (97036) $154.20
Application of a modality to 1 or more areas; iontophoresis, each 15 minutes Other Outpatient (97033) $154.50
Application of a modality to 1 or more areas; ultrasound, each 15 minutes Other Outpatient (97035) $82.75
Application of a modality to 1 or more areas; vasopneumatic devices Other Outpatient (97016) $86.65
Assessment of aphasia (96105) $697.08
Behavioral & qualit analysis voice and resonance (92524) $534.20
Biopsy of heart lining (93505) $15,535.55
Bipap initial day (94660) $1,559.82
Breath hydrogen/methane test (91065) $765
Breathing capacity test (94010) $758.40
Bronchial allergy tests (95070) $2,395.05
Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration (94060) $1,460.55
Bundle of his recording (93600) $37,477.60
C motor evoked lwr limbs (95929) $2,521.10
Canalith repositioning (95992) $241.25
Car seat/bed test inft thru 12 mo 60 min (94780) $171.95
Cardiopulmonary exercise testing (94621) $1,752.65
Cardiovascular procedure unlisted (93799) $1,345.50
Cardiovascular stress test (93017) $1,460.55
Cardioversion elective external (92960) $3,680.60
Caregiver training 1st 30 min (97550) $158.20
Caregiver training ea addl 15 (97551) $79.50
Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary… (93460) $15,428.60
Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary… (93459) $18,514.30
Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary… (93458) $18,514.30
Chemo anti-neopl sq/im (96401) $385.40
Chemo hormon antineopl sq/im (96402) $418.40
Chemo intralesional over 7 (96406) $1,292.75
Chemo intralesional up to 7 (96405) $714
Chemo IV infus each addl seq (96417) $647.20
Chemo IV infusion addl hr (96415) $640.50
Chemo IV push addl drug (96411) $719.35
Chemother prolong infuse w/pump (96416) $1,994.85
Chemotherapy administration into the peritoneal cavity via implanted port or catheter (96446) $2,081.55
Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug (96413) $1,809.95
Chemotherapy administration; intravenous, push technique, single or initial substance/drug (96409) $1,077.30
Chemotherapy injection, subarachnoid or intraventricular via subcutaneous reservoir, single or multiple agents (96542) $1,292.75
Chest physiotherapy initial (94667) $726.65
Color/duplex Doppler, complete (93975) $1,362.85
Color/duplex Doppler, limited (93976) $739.25
Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or… (97537) $138.75
Compre electrophysiologic w/o arrhyt induction (93619) $37,477.60
Compre ep eval abltj atr fib pulm vein isolation (93656) $101,060.10
Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with… (93620) $42,134.10
Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction… (93653) $93,858.10
Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction… (93654) $88,342.40
Concurrent chemotherapy (96549) $265.15
Cont gluc mntr physician/qhp provided equipment (95250) $630.30
Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour (94644) $726.65
Coronary art/grft angio s&i (93455) $15,428.60
Coronary artery angio s&i (93454) $18,514.30
Cpr (92950) $1,460.55
Critical care ill/injured patient init 30-74 min (99291) $4,804.45
Debridement open wound 20 sq cm< (97597) $1,073.55
Delivery/birthing room resuscitation (99465) $3,722.50
Dialysis one evaluation (90945) $1,990.15
Dup-scan artl infl&ven o/f pen vsl compl (93980) $616.05
Duplex hemodialysis access (93990) $668.85
Duplex scan artl infl&ven o/f hemo compl bi std (93985) $1,301.95
Duplex scan artl infl&ven o/f hemo compl uni std (93986) $1,815.10
Duplex scan of extracranial arteries; complete bilateral study Age Under 21 (93880) $1,301.95
Duplex scan of extracranial arteries; unilateral or limited study Age Under 21 (93882) $616.05
Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study Age… (93970) $1,562.35
Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study Age… (93971) $616.05
Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93925) $1,613.60
Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93926) $1,404.40
Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93930) $2,787.40
Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93931) $2,066.70
ECG monit/reprt up to 48 hrs (93226) $1,265
Echo transesophageal (93312) $3,243.62
Echo tthrc r-t 2d w/wo m-mode rest&strs cont ECG (93351) $2,623.85
Echocardiography, transesophageal (TEE) for monitoring purposes, including probe placement, real time 2-dimensional… (93318) $3,025.15
EEG 41-60 minutes (95812) $3,080.20
EEG awake & asleep (95819) $3,080.20
EEG awake/drowsy (95816) $3,080.20
EEG coma or sleep only (95822) $3,080.20
EEG cont rec w/video by tech min 8 channels (95700) $1,547.60
EEG extended monitoring 61-119 minutes (95813) $3,080.20
EEG w/o vid by tech ea incr 12-26 hr intmt mntr (95709) $5,248.40
EEG w/o vid by tech ea incr 12-26hr unmonitored (95708) $5,248.40
EEG w/o vid tech ea incr 12-26 hr cont r-t mntr (95710) $5,248.40
EEG w/o video by tech 2-12 hr intermittent mntr (95706) $3,080.20
EEG w/o video by tech 2-12 hr unmonitored (95705) $3,080.20
EEG w/o video by tech 2-12hr continuous r-t mntr (95707) $3,080.20
EKG 12 lead tracing only (93005) $413.65
EKG rhythm strip (93041) $359.70
Elec alys implt cplx cn npgt prgrmg (95977) $285.70
Electrophysiologic evaluation of single or dual chamber transvenous pacing cardioverter-defibrillator (includes… (93642) $6,990.65
Electrophysiologic follow-up study with pacing and recording to test effectiveness of therapy, including induction or… (93624) $42,134.10
Emergency department visit high mdm (99285) $3,430.10
Emergency department visit low mdm (99283) $1,656.95
Emergency department visit may not req phys/qhp (99281) $469.90
Emergency department visit moderate mdm (99284) $2,558.80
Emergency department visit straightforward mdm (99282) $874.20
End tidal co2 mntrng (crbn dxde exp gas dtrmntn by infrared analyzer) (94799) $758.40
Endoscopy swallow (fees) vid (92612) $958.20
Esoph balloon distension tst (91040) $1,591.80
Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and… (91010) $4,392.50
Esophageal recording (93615) $7,581.60
Esophageal recording of atrial electrogram with or without ventricular electrogram(s); with pacing without Cardiac Cath (93616) $7,596.80
Eval of Oral and Pharyngeal Swallowing - Eval of Oral and Pharyngeal Swallowing Fx Chg (92610) $616.30
Evaluate pt use of inhaler (94664) $788.10
Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with… (92608) $504.30
Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with… (92607) $958.20
Evaluation of speech fluency (92521) $858.25
Evaluation of speech sound production articulate (92522) $597.05
Ext ECG>48hr<7d scan a/r (93243) $486.85
External ECG rec>48hr<7d recording (93242) $325.05
External ECG rec>7d<15d recording (93246) $344.75
External ECG rec>7d<15d scanning alys w/report (93247) $486.85
External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes… (93225) $605.50
External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data… (93229) $2,074.80
Fluidotherapy (97022) $120.70
Gastroesophag reflx test w/cath ph eltrd plcmt (91034) $3,322.70
Gastroesophag reflx test w/telemtry ph eltrd (91035) $8,084.40
Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), colon, with interpretation and report Age Under 21 (91113) $5,200.70
Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus through ileum, with interpretation and… (91110) $5,166.10
Group caregiver training strategies & technique (97552) $72.35
Hemodialysis procedure w/ phys/qhp evaluation (90935) $3,945.85
Im adm intransl/oral 1 vaccine (90473) $21.17
Imaging of retina for detection or monitoring of disease; with remote physician or other qualified health care… (92228) $177.10
Imm admn sarscov2 vaccine single dose (90480) $59.04
Immunization administration (90471) $140.65
Induction of arrhythmia by electrical pacing without Cardiac Cath (93618) $6,867.35
Injection,Therap/Proph/Diagnost, IV Push, Ea Add, New Drug (96375) $384.40
Injection,Therap/Proph/Diagnost, IV Push, Initial Drug (96374) $814.85
Insertion and placement of flow directed catheter (eg, Swan-Ganz) for monitoring purposes with Cardiac Cath (93503) $9,699.05
Interrogation vad in prson w/phys/qhp analysis (93750) $520.50
Intra-atrial pacing (93610) $37,477.60
Intra-atrial recording (93602) $37,477.60
Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete… (93650) $36,172.50
Intraventricular pacing (93612) $37,477.60
Irrigaj implntd venous access drug delivery syst (96523) $299.75
IV infusion hydration each additional hour (96361) $313.25
IV infusion hydration initial 31 min-1 hour (96360) $1,029.25
IV infusion ther proph addl sequential to 1 hr (96367) $404.65
IV infusion therapy/prophylaxis /dx 1st to 1 hr (96365) $1,058.30
IV tx, each additional hour (96366) $313.25
Low frequency non-thermal us (97610) $941.75
Lwr xtr vasc stdy bilat (93924) $1,537.40
Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent (94668) $726.65
Maximum voluntary ventilation (94200) $359.70
Measurement of brain wave activity (EEG) to evaluate brain death (95824) $5,248.40
Mechanical chest wall oscillation lung function (94669) $1,138.50
Mechanical traction therapy (97012) $81.30
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $132.30
Medical nutrition group (97804) $77.10
Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes… (97803) $139.25
Methacholine challenge (94070) $1,752.65
Motion fluoroscopic evaluation of swallowing function by cine or video recording Other Outpatient (92611) $653.20
Multiple sleep latency (95805) $5,248.40
Nasopharyngoscopy (92511) $649.05
Neg pressure wound therapy non dme </= 50 sq cm (97607) $1,945.60
Neg pressure wound therapy non dme >50 sq cm (97608) $2,235.10
Negative pressure wound therapy dme </= 50 sq cm (97605) $1,029.90
Negative pressure wound therapy dme >50 sq cm (97606) $2,352.75
Non-invasive physiologic study extremity 3 levels (93923) $798.35
Noninvasive ear/pulse oximetry overnight monitor (94762) $758.40
Occupational therapy eval high complex 60 mins (97167) $307.15
Occupational therapy eval low complex 30 mins (97165) $301.80
Occupational therapy eval mod complex 45 mins (97166) $304.50
Oral function therapy (92526) $393.05
Oral speech device eval (92597) $212.70
Orthc/prostc mgmt sbsq enc (97763) $172.75
Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper… (97760) $157.70
Osteopath manj 1-2 regions (98925) $76.95
Ot manual therapy ea 15 min (97140) $136.95
Ot neuromuscular re-education (97112) $171.80
Ot paraffin bath (97018) $193.70
Ot re-evaluation (97168) $245.75
OT Therapeutic Activities Charges (97530) $129.45
Ot wheelchair management (97542) $142
Other physical medicine or rehabilitation service or procedure (97799) $259.35
Outpatient cardiac rehab w/cont ECG monitoring (93798) $695.70
Outpatient cardiac rehab w/o cont ECG monitor (93797) $594.85
Oxygen uptake, expired gas analysis; rest, indirect (separate procedure) (94690) $403.60
Peripheral vascular rehab (93668) $299.75
Perq transcath closure pda (93582) $68,079.35
Perq transcath cls paravalvr leak 1 aortic valve (93591) $51,996.50
Perq transcath cls paravalvr leak 1 mitral valve (93590) $57,172.95
Pharmacological or physical activation requiring physician or other qualified health care professional attendance… (95954) $5,248.40
Phlebotomy therapeutic (99195) $726.65
Phy/qhp op pulm rhb w/mntr (94626) $474.90
Phy/qhp op pulm rhb w/o mntr (94625) $499.85
Physical therapy evaluation high complex 45 mins (97163) $307.15
Physical therapy evaluation low complex 20 mins (97161) $301.80
Physical therapy evaluation mod complex 30 mins (97162) $304.50
Pm device progr eval multi (93281) $225.35
Polysom 6/>yrs sleep w/cpap 4/> addl param attnd (95811) $10,063.45
Polysom <6 yrs sleep w/cpap/bilvl vent 4/> param (95783) $10,063.45
Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a… (95782) $10,063.45
Pr unlisted therapeutic procedure specify (97139) $75.90
Program eval implantable in persn dual ld pacer (93280) $211.25
Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of… (93284) $211.25
Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of… (93283) $220.40
Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes Other… (97761) $268.95
Prq trluml coronary angio/atherect one art/brnch (92924) $38,226.60
Prq trluml coronary angioplasty one art/branch (92920) $33,943.94
Prq trluml coronary byp grft revasc one vessel (92937) $50,137.72
Prq trluml coronary stent w/angio one art/brnch (92928) $41,987.92
Prq trluml coronry chronic occlus revasc one vsl (92943) $50,137.72
Prq trluml coronry stent/ath/angio one art/brnch (92933) $67,933.58
Pt gait training 15 min (97116) $111
Pt physical performance test (97750) $130.85
Pt re-evaluation (97164) $222.35
Pt Work Hardening/conditioningwork Reconditioning Initial Charge (97545) $425.75
Pulm funct tst plethysmograp (94726) $1,460.55
Pulmonary stress testing (94618) $605.50
R hrt art/grft angio (93457) $15,428.60
R hrt cath chd w/img cath trgt zone nml nt connj (93593) $9,662.55
R hrt coronary artery angio (93456) $15,428.60
R&l hrt art/ventricle angio (93461) $15,428.60
R&l hrt cath w/ventriclgrphy (93453) $15,428.60
Recording to evaluate height and duration of heart beats through damaged heart tissue (93278) $757.25
Refilling and maintenance of portable pump (96521) $1,176.95
Rem interrog scrms <30 d phys/qhp (93298) $116.10
Remote 30 day ECG rev/report (93270) $815.95
Rfl&main implt pmp/rsvr dlvr spi/brn phy/qhp (95991) $1,701.50
Right heart cath o2 saturation & cardiac output (93451) $19,285.70
Right ventricular recording (93603) $19,643.15
Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation,… (97535) $137.95
Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands,… (97533) $126.35
Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording… (95938) $2,521.10
Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording… (95926) $1,460.55
Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording… (95925) $1,460.55
Sleep study unattended (95806) $1,547.60
Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (eg, by airflow or… (95800) $1,547.60
Speech sound lang comprehen (92523) $534.20
Standardized cognitive performance testing (96125) $858.25
Stress tte only (93350) $2,623.85
Surfactant administration (94610) $1,198.45
Temp transcutaneous pacing (92953) $3,067.20
Test for hearing various pitches using earphone (92552) $605.50
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $130.60
Ther ivntj cog funcj cntct ea addl 15 minutes (97130) $102.60
Therapeutic procedure(s), group (2 or more individuals) Other Outpatient (97150) $262.30
Therapeutic procedure, 1 or more areas, each 15 minutes; aquatic therapy with therapeutic exercises Other Outpatient (97113) $143.70
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement… (97124) $80.90
Therapeutic prophylactic/dx injection subq/im (96372) $384.40
Therapeutic services for the use of speech-generating device, including programming and modification Other Outpatient (92609) $809
Tilt table evaluation (93660) $3,025.35
Tobacco use cessation intensive >10 minutes (99407) $157.70
Tobacco use cessation intermediate 3-10 minutes (99406) $147.05
Transcath closure of asd (93580) $71,706.50
Transcranial doppler stdy intracranial art compl (93886) $1,461.40
Transcranial Doppler study of the intracranial arteries; limited study Age Under 21 (93888) $886.45
Transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition,… (93315) $2,623.85
Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study Age Under 21 (93304) $2,576.56
Tte congenital complete (93303) $2,679.02
Tte f-up or lmtd (93308) $1,461.40
Tte w/doppler complete (93306) $3,148.60
Tx of Speech/Lang/Voice/Comm/Auditory Chg (92507) $455.80
Tx speech language voice commj auditry 2/>indiv (92508) $264.55
Upr/l xtremity art 2 levels (93922) $638
Valvuloplasty aortic valve (92986) $27,198.65
Valvuloplasty mitral valve (92987) $39,458.55
Veeg by tech 2-12 hours unmonitored (95711) $3,080.20
Veeg by tech 2-12 hr continuous r-t monitoring (95713) $5,248.40
Veeg by tech 2-12 hr intermittent monitoring (95712) $3,080.20
Veeg by tech ea incr 12-26 hr cont r-t mntr (95716) $10,063.45
Veeg by tech ea incr 12-26 hr intermittent mntr (95715) $5,248.40
Veeg by tech ea incr 12-26 hr unmonitored (95714) $5,248.40
Ventilation ip/obs initial day (94002) $3,986.45
Ventilator subsequent day (94003) $3,791.85
Visual ep testing cns except glaucoma w/i&r (95930) $1,659.55
Vital capacity total (94150) $910.10
Wada activation test (95958) $10,063.45
Work hardening/conditioning; each additional hour (List separately in addition to code for primary procedure) (97546) $151.45
Wound(s) care non-selective (97602) $894.65