Visits & medical services prices at St. Thomas More Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Aerosol inhalation pentamidine (94642) $113.68 $284.19 0.5×
Airway inhalation treatment (94640) $113.68 $284.19 0.5×
Ambulatory blood pressure monitoring, utilizing report-generating software, automated, worn continuously for 24 hours… (93788) $394.53 $986.31 2.8×
Ambulatory bp recording (93786) $424.65 $1,061.62 3.0×
Appl on-body injector for timed subq injection (96377) $78.66 $196.65 1.6×
Application of a modality to 1 or more areas; contrast baths, each 15 minutes Other Outpatient (97034) $37.71 $94.26
Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes Other Outpatient (97032) $43.35 $108.37
Application of a modality to 1 or more areas; iontophoresis, each 15 minutes Other Outpatient (97033) $32.88 $82.18
Application of a modality to 1 or more areas; ultrasound, each 15 minutes Other Outpatient (97035) $50.25 $125.62
Application of a modality to 1 or more areas; vasopneumatic devices Other Outpatient (97016) $96.92 $242.28
Assessment of aphasia (96105) $89.29 $223.22
Behavioral & qualit analysis voice and resonance (92524) $152.86 $382.15
Biofeedback training by any modality Other Outpatient (90901) $178.80 $446.98
Bipap initial day (94660) $435.47 $1,088.67 1.9×
Breathing capacity test (94010) $131.82 $329.53 0.6×
Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration (94060) $200.01 $500.02 0.5×
C motor evoked lwr limbs (95929) $1,064.26 $2,660.65 2.7×
C motor evoked uppr limbs (95928) $1,064.26 $2,660.65 1.2×
Canalith repositioning (95992) $28.30 $70.74
Cardiovascular stress test (93017) $482.60 $1,206.48 2.1×
Cardioversion elective external (92960) $766.80 $1,916.98 1.1×
Caregiver training 1st 30 min (97550) $45.12 $112.78
Caregiver training ea addl 15 (97551) $20.64 $51.58
Chemo anti-neopl sq/im (96401) $235.84 $589.60 3.1×
Chemo hormon antineopl sq/im (96402) $381.74 $954.35 5.0×
Chemo IV infus each addl seq (96417) $217.91 $544.77 2.9×
Chemo IV infusion addl hr (96415) $272.82 $682.03 3.6×
Chemo IV push addl drug (96411) $509.12 $1,272.80 6.7×
Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug (96413) $290.41 $726.01 0.8×
Chemotherapy administration; intravenous, push technique, single or initial substance/drug (96409) $509.12 $1,272.80 1.5×
Chest physiotherapy initial (94667) $68.30 $170.75 0.5×
Color/duplex Doppler, complete (93975) $646.63 $1,616.56 2.6×
Color/duplex Doppler, limited (93976) $532.74 $1,331.83 4.8×
Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or… (97537) $71.99 $179.96
Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour (94644) $132.28 $330.68 0.9×
Cpr (92950) $1,716.76 $4,291.89 7.5×
Critical care ill/injured patient init 30-74 min (99291) $3,742.60 $9,356.50 4.3×
Ctr motr ep std transcrnl motr stim upr&low limb (95939) $1,596.39 $3,990.97 1.8×
Debridement open wound 20 sq cm< (97597) $333.40 $833.50 1.6×
Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study Age Under 21 (93978) $870.12 $2,175.30 3.5×
Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; unilateral or limited study Age Under 21 (93979) $711.26 $1,778.15 6.4×
Duplex scan of extracranial arteries; complete bilateral study Age Under 21 (93880) $545.75 $1,364.37 2.2×
Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study Age… (93970) $1,050.84 $2,627.10 4.2×
Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study Age… (93971) $700.54 $1,751.35 6.4×
ECG monit/reprt up to 48 hrs (93226) $213.76 $534.39 3.4×
ECG/monitoring and analysis (93271) $430.09 $1,075.22 4.3×
Echo tthrc r-t 2d w/wo m-mode rest&strs cont ECG (93351) $1,430.15 $3,575.37 2.5×
Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed,… (93307) $580.90 $1,452.23 2.3×
EEG 41-60 minutes (95812) $355.90 $889.73 1.6×
EEG awake & asleep (95819) $684.80 $1,711.98 3.0×
EEG awake/drowsy (95816) $684.80 $1,711.98 3.0×
EEG coma or sleep only (95822) $684.80 $1,711.98 3.0×
EEG extended monitoring 61-119 minutes (95813) $1,310.56 $3,276.40 5.8×
EKG 12 lead tracing only (93005) $60.32 $150.78 1.0×
EKG rhythm strip (93041) $90.67 $226.67 1.5×
Elec alys implt npgt smpl sp/pn npgt prgrmg (95971) $1,618.10 $4,045.24 16.1×
Electrode stimulation brain (95961) $1,596.39 $3,990.97 1.8×
Emergency department visit high mdm (99285) $2,267.30 $5,668.25 3.6×
Emergency department visit low mdm (99283) $650.92 $1,627.30 2.3×
Emergency department visit may not req phys/qhp (99281) $216.05 $540.11 2.4×
Emergency department visit moderate mdm (99284) $1,175.73 $2,939.32 2.7×
Emergency department visit straightforward mdm (99282) $324.17 $810.41 2.0×
End tidal co2 mntrng (crbn dxde exp gas dtrmntn by infrared analyzer) (94799) $243.30 $608.24 1.8×
Endoscopy swallow (fees) vid (92612) $230.13 $575.31
Eval of Oral and Pharyngeal Swallowing - Eval of Oral and Pharyngeal Swallowing Fx Chg (92610) $114.77 $286.92
Evaluate pt use of inhaler (94664) $296.99 $742.46 1.3×
Evaluation of speech sound production articulate (92522) $146.67 $366.67
Exercise test for bronchospasm, including pre- and post-spirometry and pulse oximetry; with electrocardiographic… (94617) $434.76 $1,086.89 3.1×
Ext ECG>48hr<7d scan a/r (93243) $60.83 $152.06 0.4×
External ECG rec>48hr<7d recording (93242) $41.49 $103.72 1.1×
External ECG rec>7d<15d recording (93246) $60.83 $152.06 1.5×
External ECG rec>7d<15d scanning alys w/report (93247) $89.01 $222.51 0.6×
External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes… (93225) $175.66 $439.15 1.3×
Fluidotherapy (97022) $77.42 $193.53
Gas dilut/washout lung vol w/wo distrib vent&vol (94727) $249.94 $624.84 1.1×
Group caregiver training strategies & technique (97552) $19.27 $48.16
Hot/cold pack (97010) $9.69 $24.22
Immunization administration (90471) $68.84 $172.08 0.9×
Infrared therapy (97026) $54.61 $136.51
Injection,Therap/Proph/Diagnost, IV Push, Ea Add, New Drug (96375) $151.86 $379.64 3.1×
Injection,Therap/Proph/Diagnost, IV Push, Initial Drug (96374) $151.86 $379.64 0.7×
Irrigaj implntd venous access drug delivery syst (96523) $78.75 $196.87 1.3×
IV infusion hydration each additional hour (96361) $88.99 $222.46 1.8×
IV infusion hydration initial 31 min-1 hour (96360) $212.48 $531.20 0.9×
IV infusion ther proph addl sequential to 1 hr (96367) $185.06 $462.64 2.4×
IV infusion therapy/prophylaxis /dx 1st to 1 hr (96365) $212.48 $531.20 0.9×
IV tx, each additional hour (96366) $167.90 $419.74 3.4×
Low frequency non-thermal us (97610) $250.95 $627.37 1.2×
Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent (94668) $58.88 $147.20 0.4×
Mechanical chest wall oscillation lung function (94669) $310.24 $775.60 1.3×
Mechanical traction therapy (97012) $53.80 $134.50
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $26.91 $67.26
Medical nutrition group (97804) $38.69 $96.71
Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes… (97803) $26.91 $67.26
Methacholine challenge (94070) $508.26 $1,270.65 1.3×
Motion fluoroscopic evaluation of swallowing function by cine or video recording Other Outpatient (92611) $200.84 $502.08
Multiple sleep latency (95805) $1,455.32 $3,638.29 1.6×
Muscle test 3 limbs (95863) $748.39 $1,870.97 5.5×
Muscle test larynx (95865) $748.39 $1,870.97 5.3×
Ndl EMG 4 xtr w/wo related paraspinal areas (95864) $997.65 $2,494.11 7.3×
Needle electromyography cranial nrv muscle uni (95867) $234.70 $586.75 1.0×
Needle measurement of electrical activity in muscles on both sides of body (95868) $352.05 $880.12 1.5×
Negative pressure wound therapy dme </= 50 sq cm (97605) $399.30 $998.23 1.9×
Negative pressure wound therapy dme >50 sq cm (97606) $370.38 $925.95 0.9×
Nerve conduction studies 3-4 studies (95908) $967.08 $2,417.69 4.2×
Non-invasive physiologic study extremity 3 levels (93923) $291.40 $728.50 1.3×
Noninvasive ear/pulse oximetry overnight monitor (94762) $411.03 $1,027.56 3.0×
Occupational therapy eval high complex 60 mins (97167) $157.81 $394.52
Occupational therapy eval low complex 30 mins (97165) $129.13 $322.82
Occupational therapy eval mod complex 45 mins (97166) $143.47 $358.67
Oral function therapy (92526) $89.76 $224.38
Orthc/prostc mgmt sbsq enc (97763) $30.96 $77.39
Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper… (97760) $43.35 $108.37
Ot manual therapy ea 15 min (97140) $61.38 $153.44
Ot neuromuscular re-education (97112) $59.09 $147.71
Ot paraffin bath (97018) $26.06 $65.13
Ot re-evaluation (97168) $118.76 $296.89
OT Therapeutic Activities Charges (97530) $57.43 $143.56
Ot wheelchair management (97542) $49.92 $124.79
Outpatient cardiac rehab w/cont ECG monitoring (93798) $174.07 $435.16 1.3×
Oxygen uptake, expired gas analysis; including CO2 output, percentage oxygen extracted (94681) $509.65 $1,274.11 1.3×
Peripheral vascular rehab (93668) $240.02 $600.02 3.9×
Phlebotomy therapeutic (99195) $64.69 $161.71 0.5×
Phy/qhp op pulm rhb w/mntr (94626) $248.29 $620.71 4.0×
Phy/qhp op pulm rhb w/o mntr (94625) $248.29 $620.71 4.0×
Physical therapy evaluation high complex 45 mins (97163) $143.47 $358.66
Physical therapy evaluation low complex 20 mins (97161) $129.13 $322.82
Physical therapy evaluation mod complex 30 mins (97162) $143.47 $358.67
Polysom 6/>yrs sleep w/cpap 4/> addl param attnd (95811) $2,664.32 $6,660.78 2.9×
Polysom <6 yrs sleep w/cpap/bilvl vent 4/> param (95783) $2,182.98 $5,457.45 2.4×
Polysomnography; any age, sleep staging with 1-3 additional parameters of sleep, attended by a technologist (95808) $2,057.08 $5,142.68 2.3×
Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a… (95782) $1,681.56 $4,203.88 1.9×
Pr unlisted therapeutic procedure specify (97139) $57.70 $144.23
Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes Other… (97761) $43.35 $108.37
Pt gait training 15 min (97116) $47.75 $119.37
Pt physical performance test (97750) $53.26 $133.15
Pt re-evaluation (97164) $119 $297.48
Pt Work Hardening/conditioningwork Reconditioning Initial Charge (97545) $239.03 $597.56
Pulm funct tst plethysmograp (94726) $147.22 $368.05 0.4×
Pulmonary stress testing (94618) $435.34 $1,088.34 3.1×
Range of motion measurements and report (separate procedure); each extremity (excluding hand) or each trunk section… (95851) $54.27 $135.67
Range of motion measurements and report (separate procedure); hand, with or without comparison with normal side Other… (95852) $54.27 $135.67
Remote 30 day ECG rev/report (93270) $105.17 $262.92 2.7×
Remote ther mntr tx mgmt phys/qhp 1st 20 min (98980) $41.44 $103.60
Remote ther mntr tx mgmt phys/qhp ea addl 20 min (98981) $33.72 $84.31
Remote therapeutic mntr 1st set-up&pt educaj eqp (98975) $16.96 $42.40 0.1×
Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); device(s)… (98977) $48.75 $121.87 1.2×
Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation,… (97535) $69.19 $172.96
Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands,… (97533) $58.29 $145.71
Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording… (95927) $156.47 $391.16 0.7×
Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording… (95938) $443.77 $1,109.42 0.5×
Sleep study unattended (95806) $223.96 $559.90 1.0×
Speech sound lang comprehen (92523) $304.73 $761.81
Standardized cognitive performance testing (96125) $91.24 $228.10
Subcut infusion, therap/proph/diagnost,ea add hour (96370) $213.60 $534 4.3×
Subcut infusion, therap/proph/diagnost,initial,1st hour (96369) $229.77 $574.42 1.0×
Surfactant administration (94610) $103.96 $259.89 0.5×
Temp transcutaneous pacing (92953) $383.02 $957.53 0.5×
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $89.96 $224.90
Ther ivntj cog funcj cntct ea addl 15 minutes (97130) $87.18 $217.95
Therapeutic procedure(s), group (2 or more individuals) Other Outpatient (97150) $66.45 $166.12
Therapeutic procedure, 1 or more areas, each 15 minutes; aquatic therapy with therapeutic exercises Other Outpatient (97113) $49.27 $123.17
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement… (97124) $49.27 $123.17
Therapeutic prophylactic/dx injection subq/im (96372) $155.60 $388.97 2.0×
Therapeutic services for the use of speech-generating device, including programming and modification Other Outpatient (92609) $132.65 $331.62
Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study Age Under 21 (93304) $450.38 $1,125.94 0.8×
Tte congenital complete (93303) $878.13 $2,195.31 1.5×
Tte f-up or lmtd (93308) $362.15 $905.36 1.4×
Tte w/doppler complete (93306) $1,110.10 $2,775.25 1.9×
Tx of Speech/Lang/Voice/Comm/Auditory Chg (92507) $112.19 $280.47
Upr/l xtremity art 2 levels (93922) $145.04 $362.60 1.0×
Ventilation ip/obs initial day (94002) $903.28 $2,258.19 1.4×
Ventilator subsequent day (94003) $725.12 $1,812.78 1.1×
Vital capacity total (94150) $136.68 $341.70 1.0×
Work hardening/conditioning; each additional hour (List separately in addition to code for primary procedure) (97546) $119.49 $298.72
Wound(s) care non-selective (97602) $104.08 $260.18 0.5×