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.

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

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ProcedureCash priceGross charge× Medicare
Ablation av node (93650) $36,172.50
Actigraphy testing recording analysis i&r (95803) $178.20
Advance care planning first 30 mins (99497) $264.35
Airway inhalation treatment (94640) $347.65
Appl on-body injector for timed subq injection (96377) $269.10
Application of heat wave therapy (97024) $130.60
Arrhythmia induction (93618) $6,867.35
Assessment of aphasia (96105) $697.08
Behavioral and qualitative analysis of voice and resonance (92524) $534.20
Breath Hydrogen/Methane Test (91065) $765
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $1,460.55
Bundle of his recording (93600) $37,477.60
Canalith Repositioning (95992) $241.25
Capsule endoscopy (91110) $5,166.10
Car seat/bed test 60 min (94780) $171.95
Cardiac Stress Tst,Tracing Only (93017) $1,460.55
Cardiopulmonary exercise testing (94621) $1,752.65
Cardiopulmonary resuscitation (92950) $1,460.55
Cardioversion (92960) $3,680.60
Caregiver training 1st 30 min (97550) $158.20
Caregiver Training Strategies&Tq Ea Addl 15 Min (97551) $79.50
Cath Cath Place/Coronary Angio, Img Super/Interp, Bypass Angio (93455) $15,428.60
Cath Cath Place/Coronary Angio, Img Super/Interp,W Right Heart Cath (93456) $15,428.60
Cath Perc Clos,Cong Interatrial Commun W/Impl (93580) $71,706.50
Cath Place/Coron Angio, Img Super/Interp, Bypass Angio,W L Hrt Ventric (93459) $18,514.30
Cath Place/Coron Angio, Img Super/Interp,W Left Heart Ventriculography (93458) $18,514.30
Cbt 1st hour (94644) $726.65
Chemo Admin Peritoneal Cavity (96446) $2,081.55
Chemo Hormon Antineopl Sq/Im (96402) $418.40
Chemo inj subarach/intravent (96542) $1,292.75
Chemo IV push addl drug (96411) $719.35
Chemo Iv Push Sngl Drug (96409) $1,077.30
Chemo prolong 8+ hrs infuse w/pump (96416) $1,994.85
Chemother, IV infusion, 1 hr (96413) $1,809.95
Chemother, IV infusion, ea add hr (96415) $640.50
Chemother,Ia Push Technique (96420) $1,977.50
Chemother,Non-Hormone Anti-Neopl, Sub-Q/Im (96401) $385.40
Chemotherapy, unspecified procedure (96549) $265.15
Chemotx Admn Cns Req Spinal Puncture (96450) $2,081.55
Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) $647.20
Color/duplex Doppler, complete (93975) $1,362.85
Color/duplex Doppler, limited (93976) $739.25
Continuous Glucose Monitoring (95250) $630.30
Coronary artery angio s&i (93454) $18,514.30
Cpap initiation and management (94660) $1,559.82
Cpt initial (94667) $726.65
Critical care (99291) $4,804.45
Ctr motor ep std transcrnl motor stimj lwr limbs (95929) $2,521.10
Debridement Open Wound 20 Sq Cm< (97597) $1,073.55
Demo &/or eval,pt use,aerosol device (94664) $788.10
Dialysis other/than hemodialysis 1 phys/qhp eval (90945) $1,990.15
Dup-scan artl infl&ven o/f pen vsl compl (93980) $616.05
Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Study (93925) $1,613.60
Dup-scan lxtr art/artl bpgs uni/lmtd study (93926) $1,404.40
Dup-Scan Uxtr Art/Artl Bpgs Compl Bi Study (93930) $2,787.40
Dup-Scan Uxtr Art/Artl Bpgs Uni/Lmtd Study (93931) $2,066.70
Dup-scan xtr veins unilateral/limited study (93971) $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 extracranial art compl bi study (93880) $1,301.95
Echo Heart Xthoracic,Limited (93308) $1,461.40
Echo transesophageal (93312) $3,243.62
Echo Transesophageal - Congenital Tee Complete (93315) $2,623.85
Echo Transthoracic - Congenital Tte Complete (93303) $2,679.02
Echo Transthoracic - Congenital Tte Limited (93304) $2,576.56
EEG awake asleep (95819) $3,080.20
EEG awake drowsy (95816) $3,080.20
EEG cerebral death evaluation (95824) $5,248.40
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 2-12 Hr Unmntr (95705) $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 2-12hr continuous r-t mntr (95707) $3,080.20
EKG (93005) $413.65
EKG rhythm strip (93041) $359.70
Ekg Signal Averaging (93278) $757.25
Elec alys implt cplx cn npgt prgrmg (95977) $285.70
Electroencephalogram Extend Monitoring 41-60 Min (95812) $3,080.20
Endomyocardial biopsy (93505) $15,535.55
Ep & ablate supravent arrhyt (93653) $93,858.10
Ep & ablate ventric tachy (93654) $88,342.40
Ep Compre Electrophysiologic Arrhythmia Induction (93620) $42,134.10
Ep Compre Electrophysiologic W/O Arrhyt Induction (93619) $37,477.60
Ep Electrophysiologic F/U Study (93624) $42,134.10
Ep Ephys Eval Pacg Cvdfb Prgrmg/Reprgrmg Parameters (93642) $6,990.65
Ep Esophageal Recording Atria+Pacing (93616) $7,596.80
Ep Right Ventricular Recording (93603) $19,643.15
Er level 1 (99281) $469.90
Er level ii (99282) $874.20
Er level iii (99283) $1,656.95
Er level IV (99284) $2,558.80
Er level v (99285) $3,430.10
Esophageal recording (93615) $7,581.60
Esophgl balo distension dx std w/provocation (91040) $1,591.80
Eval&/Fitg Voice Prostc Dev Suplmnt Oral Speec (92597) $212.70
Evaluation of speech fluency (92521) $858.25
Evaluation of speech sound production (92522) $597.05
Evaluation of swallowing function (92610) $616.30
Evaluation with prescription of speech-generating alternative (92607) $958.20
Exhaled Air Analysis (94690) $403.60
External ECG rec>48hr<7d recording (93242) $325.05
External ECG rec>48hr<7d scanning alys w/report (93243) $486.85
External ECG rec>7d<15d recording (93246) $344.75
External ECG rec>7d<15d scanning alys w/report (93247) $486.85
External Ecg Scanning Analysis Report (93226) $1,265
Flexible Endoscopic Eval Swallow C/V Rec (92612) $958.20
Gastroesophag Reflx Test W/Cath Ph Eltrd Plcmt (91034) $3,322.70
Gastroesophag reflx test w/telemtry ph eltrd (91035) $8,084.40
Group Therapeutic Procedures (97150) $262.30
Hemodialysis (90935) $3,945.85
Holter Monitor Recording (93225) $605.50
Hydrotherapy (97036) $154.20
Imaging of colon using capsule endoscope, with interpretation and report (91113) $5,200.70
Img Retina Detcj/Mntr Ds Rem Phys/Qhp I&R Uni/Bi (92228) $177.10
Imm Admn Sarscov2 Vaccine Single Dose (90480) $59.04
Immuniz admin,intranasal/oral,1 vac/tox (90473) $21.17
Immunization Admin (90471) $140.65
Inhlj Brncl Challenge Tstg W/Histamine/Methachol (95070) $2,395.05
Ins swan ganz bedside (93503) $9,699.05
Interrogation of vad (93750) $520.50
Intra Atrial Recording (93602) $37,477.60
Intra-atrial pacing (93610) $37,477.60
Intralesional Chemo Admin,8+ Lesn (96406) $1,292.75
Intralesional Chemo Admin,<8 Lesn (96405) $714
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, therap/proph/diagnost,add infusion,1st hour (96367) $404.65
IV infusion, therap/proph/diagnost,initial,1st hour (96365) $1,058.30
IV infusion, therap/proph/diagnost,initial,ea add hour (96366) $313.25
IV push initial (96374) $814.85
Low frequency non-thermal us (97610) $941.75
Manual therapy 15 min (97140) $136.95
Massage 15 min (97124) $80.90
Maximum voluntary ventilation (94200) $359.70
Mechanical chest wall oscillation (94669) $1,138.50
Mechanical traction (97012) $81.30
Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) $139.25
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $132.30
Methacholine challenge (94070) $1,752.65
Mnt Group Ea 30 Min (97804) $77.10
Motility study esophagus (91010) $4,392.50
Motion Fluor Eval Swlng Funcj C/V Rec (92611) $653.20
Multiple sleep latency test (95805) $5,248.40
Nasopharyngoscopy (92511) $649.05
Neg press wnd tx </=50 sq cm (97607) $1,945.60
Neg press wound tx >50 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
Newborn resuscitation (99465) $3,722.50
Non-Invas Physiologic Std Extremity Art 2 Level (93922) $638
Non-Invasive Physiologic Study Extremity 3 Levls (93923) $798.35
Noninvasive Ear/Pulse Oximetry Overnight Monitor (94762) $758.40
Orthotics mgmt & traing initial enctr ea 15 mins (97760) $157.70
Osteopathic manipulative tx 1-2 body regions (98925) $76.95
Ot Community/Work Reintegration Trainj Ea 15 Min (97537) $138.75
Ot Contrast Bath Ea 15 Min (97034) $212.80
Ot eval high complex 60 min (97167) $307.15
Ot eval low complex 30 min (97165) $301.80
Ot eval mod complex 45 min (97166) $304.50
Ot Orthotics/Prosth Mgmt &/Trainj Sbsq Enctr 15 Min (97763) $172.75
Ot Prosthetic Training, Each 15 Min (97761) $268.95
Ot re-eval est plan care (97168) $245.75
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $695.70
Outpatient cardiac rehab w/o cont ECG monitor (93797) $594.85
Paraffin bath (97018) $193.70
Pentamidine Aersl Inhalation Pneumocystis/Proph (94642) $1,198.45
Peripheral arterial disease rehab per session (93668) $299.75
Perq transcath closure pda (93582) $68,079.35
Perq Transcath Cls Mitral (93590) $57,172.95
Perq transcath cls paravalvr leak 1 aortic valve (93591) $51,996.50
Phy/qhp op pulm rhb w/mntr (94626) $474.90
Phy/qhp op pulm rhb w/o mntr (94625) $499.85
Plethysmography (94726) $1,460.55
Pm device progr eval dual (93280) $211.25
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 4/> paramtrs (95782) $10,063.45
Polysom <6 Yrs Sleep W/Cpap/Bilvl Vent 4/> Param (95783) $10,063.45
Prgrmg Eval Implantable Dfb - Cardiac Device Clinic Icd Biv Chamber (93284) $211.25
Programming of dual lead implantable defibrillator system (93283) $220.40
Prq balloon valvuloplasty aortic valve (92986) $27,198.65
Prq Balloon Valvuloplasty Mitral Valve (92987) $39,458.55
Prq card revasc chronic 1vsl (92943) $50,137.72
Prq Card Stent W/Angio 1 Vsl (92928) $41,987.92
Prq Card Stent/Ath/Angio (92933) $67,933.58
Prq revasc byp graft 1 vsl (92937) $50,137.72
Prq trluml coronary angio/atherect one art/brnch (92924) $38,226.60
Prq trluml coronary angioplasty one art/branch (92920) $33,943.94
Pt Aquatic Therapy/Exercises (97113) $143.70
Pt Electric Current Therapy (97033) $154.50
Pt Electrical Stimulation (97032) $85.25
Pt eval high complex 45 min (97163) $307.15
Pt eval low complex 20 min (97161) $301.80
Pt Gait Training Therapy (97116) $111
Pt group caregiver training (97552) $72.35
Pt Neuromusc Reeducat,1+ Areas, Ea 15 Min (97112) $171.80
Pt Physical Performance Test (97750) $130.85
Pt Physical Therapy Evaluation Mod Complex 30 Mins (97162) $304.50
Pt re-evaluation (97164) $222.35
Pt Self-Care/Home Mgmt Training Each 15 Minutes (97535) $137.95
Pt Ultrasound Therapy (97035) $82.75
Pt Whirlpool Therapy (97022) $120.70
Pulmonary stress testing (94618) $605.50
Pure Tone Audiometry, Air (92552) $605.50
R & l hrt cath w/njx l ventriculog img s&i (93453) $15,428.60
R & L Hrt Cath Winjx Hrt Art& L Ventr Img (93460) $15,428.60
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& L Hrt Cath W/Injec Hrt Art/Grft& L Vent I (93461) $15,428.60
Refill/maint, portable pump (96521) $1,176.95
Rem Interrog Scrms <30 D Phys/Qhp (93298) $116.10
Remote 30 Day Ecg Rev/Report - Cardiac Event Monitor (93270) $815.95
Rfl&Main Implt Pmp/Rsvr Dlvr Spi/Brn Phy/Qhp (95991) $1,701.50
Right heart cath (93451) $19,285.70
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) $894.65
Rt Chest Wall Manipulation,Subsequent (94668) $726.65
Rx Sp-Genratj Augmnt&Comunicaj Dev Ea 30 Min (92608) $504.30
Rx/Physical Eeg Activaj Phys/Qhp Attendance (95954) $5,248.40
Sensory Integration Ea 15 Min (97533) $126.35
Short-latency somatosens ep std lwr limbs (95926) $1,460.55
Short-latency somatosens ep std upr limbs (95925) $1,460.55
Sleep study unattended (95806) $1,547.60
Slp Stdy Unatnd W/Hrt Rate/O2 Sat/Resp/Slp Time (95800) $1,547.60
Smoking cessation > 10 min (99407) $157.70
Somatosensory testing (95938) $2,521.10
Speech group therapy (92508) $264.55
Speech sound lang comprehen (92523) $534.20
Spirometry (94010) $758.40
Standardized Cognitive Performance Testing (96125) $858.25
Stress echo (93350) $2,623.85
Stress Tte Complete (93351) $2,623.85
Surfactant Admin Thru Tube (94610) $1,198.45
Temp transcutaneous pacing (92953) $3,067.20
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $130.60
Ther Ivntj Cog Funcj Cntct Ea Addl 15 Minutes (97130) $102.60
Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) $809
Ther/Proph/Diag Inj Sc/Im (96372) $384.40
Therapeutic Activities (97530) $129.45
Therapeutic phlebotomy (99195) $726.65
Tilt Table Eval (93660) $3,025.35
Tobacco Use Cessation Intermediate 3-10 Minutes (99406) $147.05
Transcran Doppler Intracran Art - Transcranial Doppler (93886) $1,461.40
Transcranial Doppler Limited (93888) $886.45
Tte W/Doppler Complete - Tte Complete W/ Contrast (93306) $3,148.60
Tx atrial fib pulm vein isol (93656) $101,060.10
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $455.80
Tx Swallowing Dysfunction&/Oral Funcj Feeding (92526) $393.05
Tx/Pro/Dx Inj New Drug Addon (96375) $384.40
Ultrasound of heart with probe in esophagus to assess heart pump function (93318) $3,025.15
Unlisted Cardiovascular Service/Procedure (93799) $1,345.50
Unlisted pulmonary service/procedure (94799) $758.40
Vasc Duplex Extrem Venous,Bilat (93970) $1,562.35
Vasc Duplex Scan Extracranial,Limited (93882) $616.05
Vasc Non-Invasive Lower Extrem Art Stress/Rest, Complete,Bilateral (93924) $1,537.40
Vasopneumatic device (97016) $86.65
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 Ea 12-26 Hr Unmntr (95714) $5,248.40
Ventilation assist & mgmt inpatient 1st day (94002) $3,986.45
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $3,791.85
Visual Evoked Potential Test (95930) $1,659.55
Vital capacity total (94150) $910.10
Wada Activation Test Hemispheric Function W/Eeg (95958) $10,063.45
Wheelchair Mgmt Ea 15 Min (97542) $142
Xtrnl mobile cv telemetry w/technical support (93229) $2,074.80