Visits & medical services prices at Sublette County Health

Pinedale, WY · every code in this section with a posted price and a Medicare benchmark.

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

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ProcedureCash priceGross charge× Medicare
Airway inhalation treatment (94640) $268.20 $298 1.2×
Appl on-body injector for timed subq injection (96377) $114.30 $127 2.4×
Application of a modality to 1 or more areas; contrast baths, each 15 minutes Other Outpatient (97034) $70.20 $78
Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes Other Outpatient (97032) $89.10 $99
Application of a modality to 1 or more areas; iontophoresis, each 15 minutes Other Outpatient (97033) $97.20 $108
Application of a modality to 1 or more areas; ultrasound, each 15 minutes Other Outpatient (97035) $89.10 $99
Application of a modality to 1 or more areas; vasopneumatic devices Other Outpatient (97016) $108.90 $121
Assessment of aphasia (96105) $405 $450
Behavioral & qualit analysis voice and resonance (92524) $332.55 $369.50
Bipap initial day (94660) $811.80 $902 3.6×
Breathing capacity test (94010) $126.90 $141 0.6×
Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration (94060) $277.20 $308 0.7×
Canalith repositioning (95992) $127.80 $142
Cardiovascular procedure unlisted (93799) $616.50 $685 4.7×
Cardiovascular stress test (93017) $1,081.80 $1,202 4.9×
Cardioversion elective external (92960) $1,840.50 $2,045 2.7×
Chemo anti-neopl sq/im (96401) $277.20 $308 3.8×
Chemo hormon antineopl sq/im (96402) $226.80 $252 3.1×
Chemo IV infus each addl seq (96417) $317.70 $353 4.3×
Chemo IV infusion addl hr (96415) $284.40 $316 3.9×
Chemo IV push addl drug (96411) $336.60 $374 4.6×
Chemother prolong infuse w/pump (96416) $718.20 $798 2.1×
Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug (96413) $727.20 $808 2.2×
Chemotherapy administration; intravenous, push technique, single or initial substance/drug (96409) $441 $490 1.3×
Chest physiotherapy initial (94667) $152.10 $169 1.1×
Color/duplex Doppler, complete (93975) $859.50 $955 3.5×
Color/duplex Doppler, limited (93976) $726.30 $807 6.8×
Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or… (97537) $90 $100
Cont gluc mntr physician/qhp provided equipment (95250) $403.20 $448 3.0×
Cont gluc mntr pt prov eqp (95249) $177.30 $197 2.9×
Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour (94644) $683.10 $759 5.0×
Cpr (92950) $759.60 $844 3.4×
Critical care ill/injured patient init 30-74 min (99291) $2,250 $2,500 2.7×
Debridement open wound 20 sq cm< (97597) $226.80 $252 1.1×
Delivery/birthing room resuscitation (99465) $634.50 $705 0.9×
Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study Age Under 21 (93978) $614.70 $683 2.5×
Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; unilateral or limited study Age Under 21 (93979) $518.40 $576 4.9×
Duplex scan of extracranial arteries; complete bilateral study Age Under 21 (93880) $1,242.90 $1,381 5.1×
Duplex scan of extracranial arteries; unilateral or limited study Age Under 21 (93882) $786.60 $874 7.4×
Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study Age… (93970) $1,337.40 $1,486 5.5×
Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study Age… (93971) $793.80 $882 7.4×
Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93925) $1,168.20 $1,298 4.8×
Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93926) $896.40 $996 8.4×
Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study Age Under 21 (93930) $1,530 $1,700 6.3×
Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study Age Under 21 (93931) $48.60 $54 0.5×
ECG monit/reprt up to 48 hrs (93226) $415.80 $462 6.9×
Echo tthrc r-t 2d w/wo m-mode rest&strs cont ECG (93351) $2,013.30 $2,237 3.6×
EEG awake/drowsy (95816) $1,521.90 $1,691 6.9×
EKG 12 lead tracing only (93005) $312.30 $347 5.2×
EKG rhythm strip (93041) $173.70 $193 2.9×
Emergency department visit high mdm (99285) $594.90 $661 1.0×
Emergency department visit low mdm (99283) $244.80 $272 0.9×
Emergency department visit may not req phys/qhp (99281) $88.20 $98 1.0×
Emergency department visit moderate mdm (99284) $362.70 $403 0.9×
Emergency department visit straightforward mdm (99282) $118.80 $132 0.8×
End tidal co2 mntrng (crbn dxde exp gas dtrmntn by infrared analyzer) (94799) $547.20 $608 4.2×
Esoph balloon distension tst (91040) $1,251.45 $1,390.50 3.3×
Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode(s)… (91037) $932.40 $1,036 4.2×
Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and… (91010) $1,109.70 $1,233 2.9×
Eval of Oral and Pharyngeal Swallowing - Eval of Oral and Pharyngeal Swallowing Fx Chg (92610) $347.40 $386
Evaluate pt use of inhaler (94664) $188.10 $209 0.8×
Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with… (92608) $220.50 $245
Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with… (92607) $354.60 $394
Evaluation of speech fluency (92521) $304.20 $338
Evaluation of speech sound production articulate (92522) $329.40 $366
External ECG rec>48hr<7d recording (93242) $290.70 $323 7.6×
External ECG rec>7d<15d recording (93246) $263.70 $293 6.9×
External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes… (93225) $415.80 $462 3.1×
Gas dilut/washout lung vol w/wo distrib vent&vol (94727) $308.70 $343 1.4×
Gastroesophag reflx test w/telemtry ph eltrd (91035) $1,712.70 $1,903 2.0×
Hot/cold pack (97010) $43.20 $48
Imm admn sarscov2 vaccine single dose (90480) $53.10 $59 1.3×
Immunization administration (90471) $111.60 $124 1.5×
Infrared therapy (97026) $53.10 $59
Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant (99460) $197.10 $219 1.4×
Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant admitted and… (99463) $230.40 $256 1.7×
Injection,Therap/Proph/Diagnost, IV Push, Ea Add, New Drug (96375) $219.60 $244 4.6×
Injection,Therap/Proph/Diagnost, IV Push, Initial Drug (96374) $288 $320 1.3×
Irrigaj implntd venous access drug delivery syst (96523) $200.70 $223 3.3×
IV infusion hydration each additional hour (96361) $253.80 $282 5.3×
IV infusion hydration initial 31 min-1 hour (96360) $494.10 $549 2.3×
IV infusion ther proph addl sequential to 1 hr (96367) $270.90 $301 3.7×
IV infusion therapy/prophylaxis /dx 1st to 1 hr (96365) $550.80 $612 2.5×
IV tx, each additional hour (96366) $213.30 $237 4.5×
Laryngeal function studies (ie, aerodynamic testing and acoustic testing) Other Outpatient (92520) $239.40 $266 1.8×
Lwr xtr vasc stdy bilat (93924) $982.80 $1,092 4.5×
Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent (94668) $183.60 $204 1.4×
Mechanical chest wall oscillation lung function (94669) $317.70 $353 1.4×
Mechanical traction therapy (97012) $94.50 $105
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $84.60 $94
Medical nutrition group (97804) $35.10 $39
Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes… (97803) $66.60 $74
Methacholine challenge (94070) $450.45 $500.50 1.2×
Motion fluoroscopic evaluation of swallowing function by cine or video recording Other Outpatient (92611) $311.40 $346
Multiple sleep latency (95805) $1,903.50 $2,115 2.2×
Neg pressure wound therapy non dme </= 50 sq cm (97607) $45 $50 0.1×
Negative pressure wound therapy dme </= 50 sq cm (97605) $189.90 $211 0.9×
Negative pressure wound therapy dme >50 sq cm (97606) $57.60 $64 0.1×
Non-invasive physiologic study extremity 3 levels (93923) $658.80 $732 3.0×
Noninvasive ear/pulse oximetry overnight monitor (94762) $348.30 $387 2.6×
Occupational therapy eval high complex 60 mins (97167) $374.40 $416
Occupational therapy eval low complex 30 mins (97165) $277.20 $308
Occupational therapy eval mod complex 45 mins (97166) $334.80 $372
Oral function therapy (92526) $261 $290
Orthc/prostc mgmt sbsq enc (97763) $121.50 $135
Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper… (97760) $124.20 $138
Ot manual therapy ea 15 min (97140) $121.50 $135
Ot neuromuscular re-education (97112) $116.10 $129
Ot paraffin bath (97018) $71.10 $79
Ot re-evaluation (97168) $208.80 $232
OT Therapeutic Activities Charges (97530) $126.90 $141
Ot wheelchair management (97542) $108 $120
Outpatient cardiac rehab w/cont ECG monitoring (93798) $282.60 $314 2.1×
Outpatient cardiac rehab w/o cont ECG monitor (93797) $262.80 $292 2.0×
Phlebotomy therapeutic (99195) $246.60 $274 1.8×
Phy/qhp op pulm rhb w/o mntr (94625) $232.20 $258 3.9×
Physical therapy evaluation high complex 45 mins (97163) $354.60 $394
Physical therapy evaluation low complex 20 mins (97161) $234.90 $261
Physical therapy evaluation mod complex 30 mins (97162) $297.90 $331
Polysom 6/>yrs sleep w/cpap 4/> addl param attnd (95811) $2,535.30 $2,817 2.9×
Polysomnography; any age, sleep staging with 1-3 additional parameters of sleep, attended by a technologist (95808) $2,658.60 $2,954 3.0×
Psycl/nrpsycl tst elec platform auto result (96146) $234.90 $261 7.9×
Pt gait training 15 min (97116) $112.50 $125
Pt physical performance test (97750) $117.90 $131
Pt re-evaluation (97164) $186.30 $207
Pt Work Hardening/conditioningwork Reconditioning Initial Charge (97545) $282.60 $314
Pulm funct tst plethysmograp (94726) $220.05 $244.50 0.6×
Pulmonary stress testing (94618) $215.10 $239 1.6×
Remote 30 day ECG rev/report (93270) $241.20 $268 6.3×
Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation,… (97535) $120.60 $134
Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands,… (97533) $122.40 $136
Sleep study unattended (95806) $351.45 $390.50 1.6×
Speech sound lang comprehen (92523) $639.90 $711
Stress tte only (93350) $1,831.50 $2,035 3.3×
Subcut infusion, therap/proph/diagnost,ea add hour (96370) $123.30 $137 2.6×
Subcut infusion, therap/proph/diagnost,initial,1st hour (96369) $486.90 $541 2.2×
Temp transcutaneous pacing (92953) $464.40 $516 0.7×
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $101.70 $113
Ther ivntj cog funcj cntct ea addl 15 minutes (97130) $109.80 $122
Therapeutic procedure(s), group (2 or more individuals) Other Outpatient (97150) $108 $120
Therapeutic procedure, 1 or more areas, each 15 minutes; aquatic therapy with therapeutic exercises Other Outpatient (97113) $235.80 $262
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement… (97124) $93.60 $104
Therapeutic prophylactic/dx injection subq/im (96372) $87.75 $97.50 1.2×
Therapeutic services for the use of speech-generating device, including programming and modification Other Outpatient (92609) $292.50 $325
Tobacco use cessation intensive >10 minutes (99407) $57.60 $64 1.5×
Tobacco use cessation intermediate 3-10 minutes (99406) $36 $40 0.9×
Tte f-up or lmtd (93308) $854.10 $949 3.5×
Tte w/doppler complete (93306) $2,287.80 $2,542 4.1×
Tx of Speech/Lang/Voice/Comm/Auditory Chg (92507) $297.90 $331
Upr/l xtremity art 2 levels (93922) $466.20 $518 3.4×
Ventilation ip/obs initial day (94002) $2,093.40 $2,326 3.3×
Ventilator subsequent day (94003) $1,116 $1,240 1.8×
Work hardening/conditioning; each additional hour (List separately in addition to code for primary procedure) (97546) $135 $150
Wound(s) care non-selective (97602) $268.20 $298 1.3×